NAVAL  HYGIENE 


PRYOR 


NAVAL  HYGIENE 


BY 


JAMES  CHAMBERS  PRYOR,  A.  M.,  M.  D, 

MEDICAL    INSPECTOR,   UNITED    STATES    NAVY;  MASTER  OF  ARTS  IN  HYGIENE, 

JOHNS  HOPKINS   UNIVERSITY;   HEAD    OF    DEPARTMENT  OF  HYGIENE, 

U.  S.   NAVAL  MEDICAL  SCHOOL;  PROFESSOR   OF    PREVENTIVE 

MEDICINE,  GEORGE  WASHINGTON  UNIVERSITY 


Published  with  Approval  of  the  Surgeon  General,  U.  S.  Navy 

AND 

By  Permission  of  the  Navy  Department 


With  153  !llu«trat.ions 


PHILADELPHIA 
P.  BLAKISTON'S  SON  &  CO. 

1012  WALNUT  STREET 


COPYRIGHT,  1918,  BY  P.  BLAKISTON'S  SON  &  Co. 


I  ILK    JVI  A  !•  L.  K    r  K  E  S  «     Y  O  K  K.    T  A. 


PREFACE 

This  work  is  offered  to  those  members  of  the  medical  profession 
whose  path  of  duty  lies  on  the  trackless  seas  with  the  hope  that  the 
author's  effort  to  supply  a  want  will  offset  any  short-comings  on  his 
part. 

Experience  in  teaching  naval  hygiene  at  the  U.S.  Naval  Medical 
School  has  demonstrated  to  the  writer  the  need  of  a  student's 
manual  of  elementary  character,  hence  this  attempt  to  supply  it. 

To  prepare  a  guide  to  a  subject  so  comprehensive  and  so  important 
in  its  bearing  upon  the  welfare  and  efficiency  of  a  naval  personnel 
requires  knowledge  derived  from  actual  extended  service  at  sea. 

Kxperience  gained  from  years  of  naval  service  in  all  parts  of  the 
world  has  given  the  writer  an  advantage  over  fellow-students  who 
have  not  lived  afloat,  and  this  leads  him  to  hope  that  the  work 
may  find  favor  not  alone  as  a  guide,  but  as  an  incentive  to  further 
study  of  the  maintenance  of  health  and  improvement  of  living  con- 
ditions afloat. 

None  appreciates  more  than  the  writer  the  breadth  of  the  subject. 
None  can  appreciate  more  than  he  the  difficulty  in  treating  it,  especially 
at  this  time  when  certain  phases  of  naval  life  are  undergoing  inter- 
esting development,  owing  to  our  participation  in  the  great  war.  A 
free  discussion  of  certain  of  these  phases,  however,  must  be  left  to 
ihe  future,  for  the  good  of  the  service. 

The  author  has  drawn  upon  all  available  sources  of  information, 
and  has  tried  to  give  due  credit  in  the  text,  without  exception;  any 
oversight  in  this  regard  will  be  deeply  regretted  by  him.  He  has 
obtained  historical  data  from  the  Encyclopedia  Britannica.  To  Rear- 
Ad  miral  E.  R.  Stitt,  Medical  Director,  U.  S.  N.,  commanding  the 
United  States  NavalMedical  School;  Medical  Director  R.  M.  Kennedy, 
N. ;  Medical  Director  C.  H.  T.  Lowndes,  U.  S.  N. ;  to  numerous 
other  naval  medical  officers,  and  to  Mr.  William  Henry  Siviter,  the 
author  is  indebted  for  assistance  and  advice. 

Naval  Constructor  J.  D.  Beuret,  U.  S.  N.,  has  kindly  furnished 
certain  illustrations  and  Pharmacist's  Mate,  3d  Class,  J.  H.  MacPher- 
son,  U.  S.  N.,  has  supplied  some  of  the  drawings. 

The  writer  is  deeply  grateful  to  his  wife  for  making  the  index — 
a  most  tedious  task — and  for  sustained  facilitation  throughout  the 

preparation  of  the  manuscript. 
UNITED  STATES  NAVAL  MEDICAL  SCHOOL, 
WASHINGTON,  D.  C. 

383077 


TABLE  OF  CONTENTS 


CHAPTER  PAGE 

I.     Introductory i 

II.     Historical 4 

»III.  Development  of  Naval  Architecture  and  Its  Influence  on  Naval 

Hygiene 7 

IV.     The  Ship 12 

V.     Air 16 

VI.     Air  Aboard  Ship 37 

VII.     Ventilation 46 

VIII.     Heating 70 

IX.    Water ^ 76 

X.    Light v 120 

XI.     Food 128 

XII.     Practical  Inspection  of  Food 161 

XIII.  Clothing 168 

XIV.  Parts  of  the  Ship  and  Health 192 

XV.     Facilities  for  Care  of  the  Sick  Aboard  Ship 242 

XVI.     Recruiting 257 

XVII.     Aviation 266 

XVIII.     Submarines 276 

XIX.     Diving 284 

XX.     Swimming 293 

XXI.     Resuscitation  of  Apparently  Drowned 303 

XXII.     Marine  Animal  Life  Dangerous  to  Man 309 

XXIII.  Insects  Which  May  Prove  Dangerous  to  Man 319 

XXIV.  The  Hospital  Ship 329 

XXV.     On  the  March 337 

XXVI.     Malingering 345 

XXVII.     Personal  Hygiene 348 

XXVIII.     Gas 357 

XXIX.     Seasickness ...  359 

XXX.    The  Nervous  System 362 

XXXI.     Nutritional  Diseases 365 

XXXII.     Heat  Cramps 367 

XXXIII.  Sputum  Borne  Diseases 374 

XXXIV.  Infectious  Diseases 379 

XXXV.     Disinfection 423 

XXXVI.     Disposal  of  the  Dead 434 

XXXVII.     Vital  Statistics 438 

XXXVIII.     Glossary  of  Nautical  Terms  Used 441 

Appendix 447 

Index   .  473 

vii 


AL  HYGIENE 


CHAPTER  I 
INTRODUCTORY 

Hygiene  is  that  branch  of  medical  science  which  concerns  itself 
with  the  preservation  of  the  health  of  individuals  and  communities. 
It  aims  to  render  "  Growth  more  perfect,  decay  less  rapid,  life  more 
vigorous,  death  more  remote." 

Hygiene  is  concerned  with  all  the  agencies  which  pertain  to  or 
affect  the  physical  condition  or  mental  state  of  man  in  his  diverse 
environment. 

In  its  broader  sense  Hygiene  comprises  many  varieties.  The 
special  object  of  this  book  is  a  consideration  of  Naval  Hygiene,  including 
camp  sanitation,  conservancy,  and  personal  hygiene. 

To  study  intelligently  the  complex  problems  which  render  "  Growth 
more  perfect,  decay  less  rapid,  life  more  vigorous,  and  death  more  re- 
mote," naval  medical  officers  must  orient  themselves  and  realize 
their  duties  require  today  that  they  care  for  men  aboard  ship  and  to- 
morrow men  in  camp  or  barracks  ashore.  The  sailor  man's  duties 
take  him  ashore,  afloat,  in  the  air  (aviation)  and  under  water  (sub- 
marines, diving). 

The  application  of  the  principles  of  hygiene  and  the  interpretation 
of  the  results  of  their  operation  are  not  spectacular.  Results  are 
at  hieved  slowly,  so  slowly  that  often  they  are  accepted  by  the  laity 
as  matter  of  fact  without  appreciation  of  what  are  in  reality  splendid 
results. 

In  commencing  a  study  of  Hygiene  and  Preventive  Medicine  it  is 
well  to  hear  in  mind  that  the  results  of  application  of  their  principles 
are  not  always  immediately  manifest. 

Many  lack  patience  to  work  in  this  field  where  a  richer  harvest 
may  reward  their  years  of  toil  than  can  be  reaped  by  them  on  ground 
v  here  the  objective  and  the  spectacular  yield  smaller  results  more 


2  NAVAL   HYGIENE 

quickly.  It  is  not  an  extravagance  10  estimate  that  fully  95  per  cent, 
of  the  aspirants  for  the  degree  of  Doctor  of  Medicine  have  been  in- 
clined to  become  surgeons  because  of  attraction  by  surgery's  spec- 
tacular achievements.  How  often  does  one  see  medical  cases  referred 
to  a  distinguished  surgeon,  not  because  such  cases  are  desired  by  the 
surgeon  or  interest  him,  but  because  his  splendid  spectacular  success 
has  attracted  the  attention  of  the  layman  who  does  not  exercise  nice 
discrimination  in  his  choice! 

The  surgeon's  patient  gets  relief,  cure,  or  a  coffin.  The  patient  of 
the  skilled  medical  colleague  shows  far  less  quick  result,  being  nursed 
back  to  health  slowly,  or  gradually  life's  tide  ebbs,  to  come  to  a  flood 
no  more. 

The  worker  in  the  field  of  Hygiene  and  Preventive  Medicine  has 
far  less  of  the  spectacular  to  attract  attention  of  a  busy  public  than 
the  surgeon,  or  than  even  the  medical  practitioner. 

Years  of  broad  and  painstaking  observation  are  required  for  the 
expression  of  results  of  his  endeavor  along  any  line,  and  even  after 
these  results  are  manifest  few  stop  to  translate  into  comprehensible 
terms  the  figures  by  which  the  results  gain  expression. 

For  instance,  in  the  registration  area  for  deaths  in  the  United  States 
the  mortality  rate  per  1000  in  1914  was  13.6,  while  in  1915  the  rate 
per  1000  in  the  same  area  was  13.5,  a  decrease  in  rate  of  o.i  per  1000. 
The  estimated  population  of  the  registration  area  for  deaths  in  the 
United  States  in  1915  was  67,333,992.  When  the  o.i  per  1000  decrease 
in  rate  is  applied  to  the  above-estimated  population  it  is  found  that 
there  were  nearly  7000  fewer  deaths  in  the  registration  area  in  1915 
than  in  1914.  Obviously  it  would  be  illogical  to  attribute  this  saving 
of  7000  lives  wholly  to  prophylaxis,  although  it  must  be  conceded 
that  preventive  measures  have  played  the  principal  role. 

The  following  is  a  striking  instance  illustrative  of  what  has  been 
accomplished  by  prophylaxis  in  the  United  States  Navy  with  reference 
to  the  prevalence  of  typhoid  fever. 

In  1912  the  administration  of  an ti- typhoid  prophylactic  became 
compulsory  in  the  Navy.  All  persons  under  forty-five  years  of  age 
were  required  to  be  inoculated  except  those  who  gave  history  of  having 
had  typhoid  fever.  Those  over  forty-five  years  of  age  were  exempt. 

During  the  decennium  immediately  preceding  the  commencement 
of  compulsory  inoculation  the  average  of  the  annual  morbidity  rates 
for  the  ten  years  was  4.11  per  1000,  and  the  average  number  of  actual 


INTRODUCTORY  3 

deaths  yearly  was  14.9,  regardless  of  annual  strength,  or  population. 
Since  compulsory  inoculation  the  average  number  of  deaths  from 
typhoid  fever  (regardless  of  strength)  in  the  Navy  has  been  1.25  per 
year.  The  difference  of  these  mortality  averages  indicates  that  13.65 
lives  probably  have  been  saved  each  year  through  compulsory  anti- 
typhoid inoculation. 

Since  1912  (the  year  during  which  the  prophylactic  was  being  ad- 
ministered) the  average  annual  rate  per  1000  for  admission  to  the  sick 
list  for  typhoid  fever  has  been  0.25,  as  against  4.1 1 ,  the  average  rate  for 
the  preceding  ten  years. 

The  total  average  strength  of  the  Navy  and  Marine  Corps  in  1916 
was  69,294  men.  Applying  the  average  rate  per  1000  before  inaugura- 
tion of  compulsory  anti- typhoid  inoculation  we  have  69,294  times 
4.11  =  284.79  cases  which  might  have  been  expected  in  1916.  Only 
17  cases  appear  in  the  official  records. 

Further  than  this,  there  has  been  a  great  reduction  in  case  rate, 
corresponding  suffering,  and  economic  loss  during  this  period. 

A  faithful  observance  of  prophylactic  measures  has  rendered  it 
possible  to  prevent  many  of  the  diseases  which  hitherto  have  scourged 
camps:  Malaria,  yellow  fever,  typhus,  typhoid,  relapsing  fever,  cholera, 
dysentery,  diphtheria,  and  others  that  might  be  mentioned  have  been 
forced  to  yield  to  the  principles  of  preventive  medicine,  and  are  no 
longer  the  dread  scourges  that  once  stalked  through  camp  and  claimed 
their  tribute  of  stalwart  men.  In  all  wars  of  which  we  have  accurate 
data,  except  the  Russo-Japanese  War,  there  have  been  about  six  deaths 
from  disease  to  every  death  caused  by  injury;  in  other  words,  disease 
is  a  far  more  formidable  foe  to  fighting  forces  than  the  enemy's  shot  and 
shell 


CHAPTER  11 
HISTORICAL 

Our  knowledge  of  the  hygienic  conditions  of  ships  in  ancient  times 
is  incomplete  and  we  are  in  want  of  contemporaneous  record  to  give  us 
data  of  value  concerning  the  living  conditions. 

In  all  this  period  of  oar-driven  vessels  naval  hygiene  had  not 
developed.  The  hygienic  conditions  were  very  unsatisfactory  from 
our  viewpoint.  Just  in  the  self-same  manner  the  fishing  boats  of 
today  are  not  properly  cared  for  from  the  standpoint  of  naval  hygiene. 

In  earliest  time  the  voyage  was  short  and  only  coastwise.  Landings 
were  often  made,  and  therefore  opportunities  were  frequent  for  replen- 
ishment of  the  provision  lockers  and  for  getting  water.  The  influence 
of  the  nautical  habitation  tended  to  change  of  thought  and  diversion, 
because  of  the  need  for  these  landings,  at  frequent  intervals. 

In  earlier  vessels  we  see  a  development  from: 

Rafts,  or  logs  tied  together;  to  the 

Dugout  (merely  a  hollowed  log) ;  then  the 

Canoe  (built  of  skin  or  bark,  having  greater  carrying  capacity) ;  followed  by  the 

Canoe  of  wood  (with  outriggers  and  sails);  then 

Vessels  of  planks  and  ribs  and  oars;  then  sails;  and  then  steam. 

The  exact  time  to  which  these  developmental  periods  may  be  referred  is  obscured 
in  the  mists  of  antiquity. 

Dugouts  of  the  Stone  Age  have  been  found  25  feet  below  the  surface  of  the  earth 
in  England. 

Egyptian  vessels  (3000  B.C.)  carried  men  and  cattle,  had  masts  and  from  22 
to  26  oars.  They  were  180  feet  long. 

The  ship  in  which  St.  Paul  and  his  companions  were  wrecked  carried  276  souls 
besides  the  cargo. 

The  Phoenicians  developed  biremes  and  triremes,  and  Greek  literature  tells  us 
that  some  of  the  Phoenician  vessels  carried  120  men. 

The  fragile  construction  of  the  earlier  ships  did  not  allow  navigation  in  heavy 
weather,  the  lack  of  a  mariner's  compass  kept  them  near  to  land,  and  these  vessels, 
constructed  with  a  flat  keel  were  frequently  dragged  ashore  and  did  not  constitute 
a  habitation  for  the  men  who  lived  in  the  open  air. 

After  this  frail  craft  followed  the  vessels  with  sails,  necessary  for  distant  naviga- 
tion and  for  voyages  of  exploration  guided  by  the  newly  discovered  mariner's  com- 
pass across  the  trackless  deep. 

4 


Then  the  nav 


HISTORICAL 


icn  the  navigators  of  the  Mediterranean  began  to  venture  into  the  Atlantic, 
Madeira,  Cape  of  Good  Hope,  America,  etc. 

]n  order  to  meet  the  demands  made  by  long  voyages  naval  architecture  under- 
went great  changes,  and  ships  became  permanent  habitations  for  their  crews;  in 
order  to  resist  the  force  of  the  waves  ships  were  built  much  stronger,  and  to  enable 
the  carrying  of  cargo  and  guns  displacement  was  increased.  The  substitution  of 
sails  for  oars  permitted  closure  of  the  deck  except  at  the  middle  hatch.  Bridges  and 
superstructures  multiplied,  the  draft  increased,  and  the  hold  was  constantly  closed 
during  the  voyage.  There  was  darkness  without  ventilation  and  these  vessels 
always  contained  a  quantity  of  stagnant  water. 

The  first  representative  vessels  were  caravels,  small  air  propelled  ships  which 
had  a  single  deck  and  two  high  citadels,  one  at  either  extremity,  with  a  crew  of  50 
men.  More  slowly  another  deck  was  added. 

Next  followed  caracks  and  galleons  with  more  superstructure  for  transporting 
passengers.  The  caracks  had  4  decks  and  2  large  citadels  at  the  ends;  the  galleons 
2  dacks  and  14  gun  ports  on  a  side. 

During  the  Crusades  vessels  of  wood,  large  and  small,  carrying  men  armed  with 
pikes  and  cutlasses  were  used. 

Gunpowder  commenced  to  be  used  about  this  time  (shortly  after  the  Crusades) 
and  had  a  great  influence  on  naval  architecture.  As  a  result,  ships  commenced 
to  grow  in  size  and  even  in  protective  arrangement  of  construction,  for  with  gun- 
powder came  a  change  in  type  of  combat. 

The  Spanish  Armada  consisted  of  132  ships  which  varied  from  100  to  1300  tons. 
When  it  is  realized  that  these  were  all  wooden  vessels  it  may  be  imagined  that  a 
i3oo-ton  vessel  was  one  of  considerable  size. 

In  the  1 8th  century  a  po-gun  ship  of  the  line  was  about  160  feet  long,  and  of 
large  displacement. 

Until  the  middle  of  the  igth  century  ships,  corvettes,  frigates,  and  brigantines 
were  the  war  vessels.  Ships  of  3  masts  and  much  more  numerous  vessels  of  smaller 
type  constituted  the  merchant  marine.  A  ship  of  3  decks  displaced  about  3000 
tons.  But  the  necessity  of  carrying  enough  ammunition  and  stores,  and  the  more 
numerous  crews  that  were  required  to  sail  and  fight  these  ships,  caused  gradual 
increase  in  size  of  the  vessels. 

In  addition,  the  long  voyage  without  possibility  of  intermediate  stop  necessi- 
tated the  carrying  of  abundant  provisions  which  added  to  the  difficulty.  The 
supply  of  water  expected  to  last  about  two  months  was  calculated  solely  upon  a 
minimum  ration  of  i  liter  per  day. 

Concerning  this  condition  of  living  the  Italian  voyageur,  Grenelli  Careri,  de- 
scribes a  voyage  to  Manila  and  Acapulco  in  1696  in  these  words: 

"The  suffering  was  in  no  wise  less  than  that  among  the  Israelites  when  they 
wandered  in  Egypt  on  their  way  to  Palestine.  One  experienced  severe  hunger, 
thirst.  sirkne>s  rold,  continued  watching  and  other  work,  and  beyond  all  this  one 
tried  to  understand  whence  all  these  suffering  came." 

Ships  continued  to  he  of  unhygienic  character,  with  slight  gradual 
improvement  in  living  conditions  until  the  early  part  of  thelastcentury, 


6  NAVAL  HYGIENE 

when  the  introduction  of  iron  in  1818  as  a  substitute  for  wood,  and  the 
introduction  of  steam  commenced  the  revolution  which  has  resulted 
in  greater  safety,  greater  comfort,  and  infinitely  greater  improvement 
in  living  conditions. 

Nelson's  flagship  "Victory"  was  of  2162  tons  displacement. 

The  first  steam  ship  to  cross  the  Atlantic  was  the  "Savannah" 
from  Savannah  to  Liverpool  in  1819.  She  was  130  feet  long,  1380  tons, 
and  was  originally  built  to  sail. 


CHAPTER  III 

DEVELOPMENT  OF  NAVAL  ARCHITECTURE  AND  ITS  INFLU- 
ENCE   ON    NAVAL   HYGIENE 


Th 

im.o  ac 


e  principal  changes  in  naval  architecture  which  must  be  taken 
account  in  hygiene  are: 
I.  The  substitution  of  steel  for  wood. 
II.  The  introduction  of  steam. 


FIG.  i. — The  United  States  Sloop-of-war  Wasp,  a  famous  war  vessel  of  the 
R<: volution.  A  wooden  ship  propelled  by  sails.  (Courtesy  of  the  Natal  Historical 
Society.) 

III.  Division  into  compartments. 

IV.  Application  of  electricity. 

The  development  of  the  submarine  vessel. 

7 


NAVAL  HYGIENE 

I.  The  Substitution  of  Steel  for  Wood. — The  substitution  of  steel 
for  wood  in  ship  construction  has  rendered  possible  the  building  of 
vessels  of  much  larger  type  and  greater  strength. 

The  iron  and  steel  vessels  can  be  made  water-tight  and  kept  so. 
Despite  careful  caulking,  the  seams  of  wooden  vessels  would  separate, 
allow  the  entrance  of  sea  water,  and  produce  a  wet  and  unsanitary 
bilge.  This  water  would  tend  to  decompose,  as  would  the  wooden 
surface  containing  it.  Foul  odors  inevitably  resulted.  Wood  satu- 
rated with  salt  water  is  difficult  to  dry  thoroughly  because  of  the  hygro- 
scopic quality  of  the  salt  which  is  left  after  evaporation  takes  place. 
The  absorbent  quality  of  wood  prevented  its  thorough  cleaning  if 
soiled  by  infectious  material.  Its  inflammability  made  it  far  more 
dangerous  to  life  than  is  the  iron  structure. 

The  very  dampness  between  decks  on  the  old  wooden  ships  was 
held  accountable  for  the  high  morbidity  rate  for  colds,  rheumatic  and 
respiratory  diseases. 

II.  The  Introduction  of  Steam. — The  introduction  of  steam  has 
rendered  living  conditions  on  board  ship  incomparably  more  comfort- 
able than  they  were  in  earlier  days.     Steam  has  shortened  the  time 
between  ports,  thus  enabling  the  more  frequent  replenishment  of  fresh 
food  supply,  and  also  has  given  to  those  who  "go  down  to  the  sea  in 
ships"  diversion  and  variety  of  scene,  which  render  less  intolerable 
monotonous  days  and  nights  aboard  ship. 

Steam  has  been  a  great  boon  to  the  sailor  man  in  that  through  it 
he  obtains  distilled  water  for  drinking  purposes,  and  may  have  fresh 
water  for  bathing  and  laundering  his  clothes. 

On  board  ship  steam  renders  possible  almost  complete  abolition 
of  water-borne  disease.  Steam  further  operates  cold  storage  plants, 
and  enables  the  keeping  of  frozen  meat  for  an  almost  indefinite  period. 

In  January,  1910,  when  making  passage  on  a  merchant  vessel  from 
Yokohama,  Japan,  to  Naples,  Italy,  ice  cream  was  served  at  the  dining 
table  while  passing  through  the  Indian  Ocean.  Inquiry  as  to  the  sourc 
of  the  ice  cream  evoked  the  following  facts: 

It  had  been  made  by  a  prominent  New  York  ice  cream  manufac- 
turer, had  been  shipped  to  Bremen,  had  been  carried  thence  throug] 
the  Mediterranean  Sea,  Isthmus  of  Suez,  Red  Sea,  etc.,  to  Yokoha 
Japan,  and  was  being  served  on  the  return  voyage  which  was  then  abou 
half  over.     This  ice  cream  had  been  actually  on  board  ship  not  less 


DEVELOPMENT   OF    NAVAL    ARCHITECTURE  9 

than  ten  weeks.     It  was  excellent,  and  no  ill  effects  are  known  to  have 
followed  its  ingestion. 

Steam  has  contributed  to  the  comfort  of  those  on  board  ship 
through  its  utilization  for  heating  purposes.  No  longer  must  the 
"dirty,  dangerous,  air-polluting  stove  be  depended  upon  for  its  stinted 
su>ply  of  heat  in  living  spaces,  and  no  longer  must,  as  formerly  was 
the  case  on  men-of-war,  solid  shot  be  heated  and  carried  from  the 
stove  to  a  sand-box,  whence  it  would  radiate  its  heat  and  give  its 
poor  comfort  to  the  shivering  occupants  of  a  room. 


FIG.  2. — A  superdreadnaught  of  today.     A  steel  steamship. 

Steam  operates  a  large  amount  of  the  auxiliary  machinery  on  board 

ship,  and  thereby  relieves  man  of  much  arduous  work.     It  renders 

possible  the  sterilization  of  clothing  arid  bedding  in  cases  of  infectious 

-e  aboard  ship,  and  permits  the  ship's  surgeon  to  do  aseptic  work. 

Steam  or  its  handmaiden,  electricity,  operates  ihe  ventilating  fans 
which  carry  fresh,  rcspirable  air  throughout  the  living  spaces,  and 
exhaust  the  polluted  air. 


10  NAVAL   HYGIENE 

Steam  renders  possible  good  light  on  board  ship,  and  prevents  the  air 
pollution  formerly  incident  upon  the  combustion  of  candles  or  oil  lamps. 

III.  Division  into  Compartments. — Division  into  compartments  has 
modified  the  effect  upon  living  on  board  ship  advantageously  and 
disadvantageously. 

Its  principal  advantages  may  be  set  down  as  follows : 

(a)  It  affords  an  easy  and  practicable  method  of  stowing  the  load 
so  as  to  prevent  shifting  of  cargo  in  case  of  heavy  weather.     The  shifting 
of  cargo  to  one  side  or  the  other  even  may  result  in  capsizing  the  ship. 

(b)  The  division  of  ships  into  water-tight  compartments  below 
the  water-line,  and  the  maintenance  of  integrity  of  these  compartments 
has  resulted  in  the  repeated  saving  of  ships  which,  had  they  not  been 
subdivided,  would  have  filled  and  sunk  upon  occasion  of  serious  injury 
to  any  part  of  their  under- water  body.     The  rush  of  inflowing  water 
is  limited  to  the  compartment  injured.     This  compartment  may  be 
flooded,  yet  the  life  of  the  ship  is  not  seriously  threatened  in  most 
instances.     If  the  ship  were  a  single  compartment  the  same  injury 
would  cause  her  to  fill  rapidly  and  go  to  the  bottom. 

(c)  Compartments  limit  to  a  great  extent  the  odors,  gases  and  wild 
heat  which  otherwise  would  pollute  the  general  body  of  air  contained 
in  the  ship. 

(d)  They  render  possible  the  privacy  of  living  spaces,  and 

(e)  Enable  the  proper  heating  of  these  spaces  without  rendering 
it  necessary  to  heat  the  entire  amount  of  air  contained  in  the  ship. 

(/)  Division  into  compartments  enables  the  carrying  of  a  variety 
of  cargo ;  for  instance,  one  compartment  may  contain  fuel  oil,  another 
fresh  water,  and  another  flour,  sugar,  or  some  substance  which  would 
be  damaged  by  contact  either  with  water  or  oil. 

(g)  Manifestly  the  division  into  rooms  and  compartments  tends  to 
limit  the  spread  of  air-borne  disease,  for  instance  droplet  infections. 

(h)  Limits  fire. — In  case  of  fire  the  stricken  portion  of  the  ship 
may  be  immediately  cut  off  from  communication  with  the  remainder 
of  the  interior,  and  the  fire  extinguished  more  easily. 

(i)  Subdivision  limits  the  effect  of  flying  fragments  of  a  bursting  shell. 

The  principal  disadvantages  lie  in  (a)  the  limitation  of  the  flow  of 
air  currents,  thus  preventing  thorough  natural  ventilation ;  (b)  in  addi- 
tional weight  of  material  which  limits  correspondingly  the  carrying 
capacity  of  the  ship;  and  (c)  additional  expense. 


DEVELOPMENT   OF    NAVAL   ARCHITECTURE  II 

IV.  The  Application  of  Electricity. — Electricity  is  used  on  board 
ship  for  illuminating  purposes,  and  the  heat  and  air  pollution  conse- 
quent upon  the  use  of  candles  and  lamps  is  prevented. 

In  certain  of  the  later  ships  electric  ovens  limit  the  amount  of  heat 
which  formerly  was  wasted  through  burning  coal  ranges.  Also  some 
ships  are  in  part  heated  with  electric  heaters.  The  ship  is  controlled 
by  systems  of  signals  and  telephones  and  the  guns  are  fired  by 
electricity. 

Much  of  the  auxiliary  machinery  is  operated  by  electricity.  The 
application  of  this  form  of  energy  has  shown  itself  to  be  valuable  in 
the  operation  of  auxiliary  machinery  formerly  driven  by  steam,  elec- 
tricity being  far  less  productive  of  wild  heat  than  would  be  the  operation 
of  the  same  machinery  by  steam. 

The  psychic  effect  upon  passengers  and  crew  of  wireless  communi- 
cations should  not  be  forgotten.  It  is  conducive  to  contentment  to 
receive  the  latest  news  from  the  world  during  the  long  voyage,  and 
further  than  this  breaking  of  the  monotony,  there  is  a  certain  sense  of 
security  in  feeling  that  the  sending  of  an  "  S.  O.  S. "  will  be  answered 
by  a  rush  of  friendly  aid  brought  by  distant  steamers. 

V.  The  Development  of  the  Submarine  Vessel. — The  development 
of  the  submarine  vessel  appears  at  present  to  concern  naval  forces 
rather  than  merchant  steamers  in  the  matter  of  bearing  upon  health. 
The  submarines  offer  problems  for  solution  peculiar  to  themselves 
which  will  be  a  subject  of  comment  elsewhere. 

It  remained  for  the  Civil  War  to  bring  the  use  of  steel  to  war-ship 
construction  and  the  development  of  the  submarine. 

Ships  armored  with  steel  for  defensive  purposes  were  not  known 
until  the  Civil  War,  when  the  Confederate  ship  "Merrimac,"  a  wooden 
ship,  was  razeed  and  her  sides  covered  with  railroad  iron  in  order  to 
protect  her  from  gun  fire. 

It  is  of  historical  interest  to  know  that  the  Confederates  also 
employed  small  cigar  shaped  boats,  made  of  boiler  iron,  hand  propelled, 
and  carrying  a  torpedo  on  a  spar.  These  small  submarines  were  called 
11  Davids,"  presumably  from  the  biblical  story  of  David  and  Goliath. 
One  of  these  "Davids"  sank  the  Federal  ship  "Housatonic." 

Today  we  have  the  palatial  passenger  steamers  which  give  one 
'all  the  comforts  of  home"  except  stability,  and  war-ships  have  de- 
veloped correspondingly. 


CHAPTER  IV 
THE  SHIP 

A  ship  is  a  hollow,  modified  spindle-shaped,  sea-going  structure  of 
steel,  concrete  or  wood,  having  quarters  for  the  crew  and  spaces  for 
passengers,  cargo,  or  both. 

Ships  are  propelled  by  wind,  steam,  electricity,  or  oil  engines. 
They  may  be  classified  as: 

1.  Merchantmen. 

(a)  Passenger  ships; 

(b)  Freighters; 

(c)  Colliers; 

(d)  Tankers; 

(e)  Fishermen; 
(/)  Tugs. 

2.  War  Vessels. 

(a)  Superdreadnaughts; 

(b)  Dreadnaughts; 

(c)  Battleships; 

(d)  Cruisers; 

(e)  Torpedo  boats; 

(/)  Torpedo  boat  destroyers; 
(g)  Submarines; 
(h)  Submarine  chasers; 
(i)  Train: 

1.  Hospital  ships; 

2.  Transports; 

3.  Colliers; 

4.  Tankers; 

5.  Supply  ships; 

6.  Water  boats; 

7.  Dispatch  boats  or  tenders; 

8.  Tugs. 


(j)    M< 


THE    SHIP  13 


onitors; 

(£)     Mine  layer-; 
(/)      Minr  sweepers. 

3.  Seagoing  Pleasure  Craft. 

(a)  Steam  yarlits: 

(b)  Auxiliary  yachts; 

(c)  Sail  yachts. 

Formerly  ships  were  built  with  a  single  hull.  Within  recent  years 
many  merchantmen  and  most  men-of-war  have  been  constructed  with 
two  hulls.  One  is  nested  inside  the  other,  but  they  are  separated  from 
each  other  by  what  is  known  as  a  double-bottom  space.  The  degree 
of  separation  between  the  two  hulls  or  shells  varies,  depending  upon 
the  plan  of  the  ship,  but  at  some  places  may  be  so  much  as  several  feet. 

This  double-bottom  space  is  subdivided  into  compartments  by 
plates,  some  of  which  are  longitudinal  and  some  transverse.  These 
compartments  at  certain  points  communicate  with  each  other  by  man- 
hole plates  which  are  water-tight  and  kept  closed  except  when  opened 
for  inspection,  airing,  or  repair. 

The  central  longitudinal  plate  is  known  as  the  keelson,  and  along 
it  on  either  side  are  the  bilge  spaces.  The  general  drainage  system 
e  ship  enters  into  these  spaces,  from  which  the  bilge  water,  as 
collection  of  drainage  water  is  called,  can  be  pumped  overboard. 

This  double-bottom  space,  divided  as  it  is  into  numerous  compart- 
ments, which  ordinarily  are  empty,  gives  additional  buoyancy  to  the 
ship,  and  greatly  increases  its  safety  in  case  of  injury  to  any  portion  of 
the  outer  hull. 

Above  the  water-line  the  double-bottom  or  cellular  construction 
does  not  persist,  but  a  single  hull  is  continued  up  to  the  weather  deck. 

Thus  far  description  has  been  limited  to  the  hull  of  the  ship.  At 
varying  intervals,  depending  upon  the  length  of  the  ship,  there  are  water- 
Light  bulkheads  which  separate  completely  one  water-tight  compart- 
ment from  another  throughout  the  entire  width  of  the  ship,  and 
extend  in  a  vertical  direction  upward  considerably  above  the  water-line. 
These  water-tight  compartments  in  certain  portions  of  ships  do  not 
communicate  with  each  other  below  the  water-line,  and  if  one  com- 
partment were  flooded  the  water  would  be  excluded  from  the  neighbor- 
ing compartments  by  the  water-tight  bulkheads  just  as  effectually  as 
it  is  excluded  by  the  ship's  hull  or  side.  At  certain  necessary  places 
these  water-tight  compartment.-  must  be  perforated  in  order  to  enable 


it  on 

is 


14  NAVAL  HYGIENE 

the  passage  of  steam  pipes,  water  pipes,  drainage  pipes,  and  electric 
lines.  In  each  of  these  cases  the  perforation  is  made  by  a  water-tight 
joint,  so  that  in  case  of  the  flooding  of  the  compartment  water  could 
not  enter  the  next  compartment  unless  the  pipes  perforating  the  bulk- 
head were  broken. 

At  the  forward  end  of  the  ship  the  hull  is  very  commonly  extended 
above  the  water-line  higher  than  elsewhere  except  at  the  extreme 
after-end,  and  a  deck  covers  over  the  space  included  between  the  hull 
at  the  forward-end  and  the  after-end.  This  portion  of  the  ship  at  the 
forward-end  is  known  as  the  forecastle,  and  the  corresponding  upward 
extension  of  the  hull  with  its  bridging  deck  at  the  after-end  is  known  as 
the  poop. 

The  forward-end  of  the  ship  is  known  as  the  bow,  and  the  opposite 
or  after-end  of  the  ship  is  called  the  stern. 

If  one  stands  facing  the  bow,  that  side  of  the  ship  on  the  right 
hand  is  known  as  the  starboard  side,  while  the  side  on  the  left  hand  is 
known  as  the  port  or  larboard.  These  terms  are  fixed  with  reference 
to  the  ship  just  exactly  as  the  terms  right  hand  and  left  hand  are  fixed 
terms  with  reference  to  an  individual. 

Midway  between  the  bow  and  stern  is  the  region  of  the  ship  com- 
monly known  as  her  "waist."  The  "eyes  of  the  ship"  refer  to  the 
section  of  the  ship  far  forward. 

"The  cabin"  is  a  term  commonly  applied  to  the  captain's  quarters, 
and  on  passenger  steamers  the  terms  first  and  second  cabin  refer  re- 
spectively to  the  spaces  occupied  by  first-  and  second-class  passengers. 

The  wardroom,  a  term  more  commonly  used  on  naval  vessels,  is 
the  space  occupied  by  the  senior  commissioned  officers.  The  sickbay 
is  the  ship's  hospital,  and  on  board  ship  the  kitchen  is  called  the  galley. 
The  water  closet  is  called  the  head.  Stairs  are  ladders  in  nautical 
parlance,  and  we  speak  of  "going  above"  or  "below  decks"  according 
to  whether  we  are  going  up  or  down  stairs.  The  floors  on  which  one 
walks  are  called  decks,  and  instead  of  the  ceiling  of  a  room  we  speak  of 
the  deck  above.  A  partition  or  wall  aboard  ship  is  called  a  "  bulkhead." 

An  opening  in  the  deck  by  which  access  may  be  had  to  spaces  bekn 
is  called  a  hatch,  and  windows  on  board  ship  are  known  as  air-ports. 

That  portion  of  the  ship  situated  above  the  weather  deck  usually 
is  referred  to  as  the  superstructure.  The  bridge  is  an  elevated  plat- 
form situated  forward  of  the  waist,  and  generally  extending  entirely 
across  the  ship.  It  is  surrounded  by  a  rail  to  prevent  falling  from  it, 


THE    SHIP  15 

and  is  the  point  from  which  the  captain  or  officer  of  the  deck  cons  the 
ship  while  she  is  underway.  From  this  bridge  extend  voice  tubes, 
engine-room  indicators,  telephones,  and  all  means  of  interior  communi- 
cation with  the  various  parts  of  the  ship.  From  the  bridge  are  also 
sent  the  signals  of  various  kinds — flags,  semaphore,  lanterns,  rockets, 
arclois,  etc.,  when  necessary. 

On  men-of-war,  as  well  as  on  passenger  steamers,  there  is  a  portion 
of  the  weather  deck  known  as  the  quarterdeck,  and  this  quarterdeck 
is  the  place  at  which  the  officer  of  the  deck  is  expected  to  receive  persons 
going  from  or  coming  on  board  ship  on  business.  The  quarterdeck 
with  its  traditions  is  regarded  almost  with  sanctity  on  board  men-of- 
war.  It  is  here  that  official  ceremonies  are  conducted  and  honors  are 
received  and  rendered  when  calls  are  made  between  naval  commanders 
of  the  ship's  own  or  other  navies. 

The  quarterdeck  space  in  port  corresponds  to  the  office  of  the 
oficer  of  the  deck,  who  is  expected  to  stand  his  watch  in  this  portion 
of  the  ship,  to  receive  persons  going  to  and  from  the  ship,  and  to 
superintend  the  receipt  and  despatch  of  stores.  So  soon  as  persons 
have  transacted  business  at  this  point  they  are  expected  to  clear  the 
quarterdeck  at  once  in  order  that  the  officer  of  the  deck  may  be  un- 
hampered in  the  performance  of  his  duties  by  having  persons  crowded 
around  him. 


CHAPTER  V 

AIR 

• 

Definition. — Pure  air  is  a  colorless,  odorless,  tasteless,  gaseous 
mixture  enveloping  the  earth. 

This  air  envelope  is  variously  stated  to  be  from  10  to  50  miles  in 
thickness,  but  the  range  of  man's  activities  above  the  earth  is  com- 
paratively small,  only  the  lower  air  strata  supporting  life. 

Great  discomfort  is  experienced  by  many  at  an  altitude  of  3000 
meters,  a  distance  of  less  than  2  miles. 

At  an  altitude  of  8600  meters,  or  4.1  miles,  Sivel  and  Croce-Spinelli  died,  while 
Tissandier,  the  third  member  of  their  party,  barely  was  able  to  bring  to  the  ground 
the  balloon  in  which  they  ascended.  The  barometric  pressure  at  an  altitude  of 
8600  meters  is  262  millimeters,  and  the  oxygen  partial  pressure  is  52.4  millimeters. 

Berson  and  Siiring  rose  to  an  altitude  of  34,500  feet  (6.5  miles)  in  1901,  and 
became  unconscious  during  the  highest  portion  of  their  flight,  even  when  using 
oxygen  inhalations. 

Hemming  and  Steyer  rose  to  a  height  of  8910  meters  (29,700  feet,  or  5.6  miles) 
in  June  1911,  but  oxygen  poverty  of  the  air  was  so  great  as  to  produce  grave  symp- 
toms requiring  oxygen  inhalations  to  save  their  lives. 

The  observatory  at  El  Mirti  in  the  Andes  is  the  highest  altitude  known  to  be 
inhabited  continuously  by  man.  It  is  5880  meters  or  3.7  miles  above  sea  level. 

Without  oxygen  inhalations  an  altitude  of  5  miles  is  the  maximum 
limit  of  man's  endurance.  The  naval  hygienist  must  consider  this  in 
connection  with  aerial  navigation. 

The  physical  characteristics  of  air  are: 

1.  Temperature; 

2.  Mobility; 

3.  Elasticity; 

4.  Density  or  weight; 

5.  Humidity  (in  its  effect  upon  man). 

Temperature. — The  atmospheric  temperature  upon  the  earth's 
surface  varies  greatly  between  two  or  more  given  points,  and  often 
fluctuates  widely  at  the  same  point,  e.g.,  in  parts  of  Africa  a  tempera- 
ture of  5o°C.  (i22°F.)  is  not  uncommon,  while  in  northern  Asia  —  7o°C. 

16 


AIR  17 

(  — 94°F.)  often  is  observed.  Again  in  certain  parts  of  the  world  a 
M-nr.-hin.u  daily  temperature  is  followed  by  great  chilling  or  free/in^ 
at  ni^ht. 

Rosenau  points  out  that  commonly  a  temperature  of  25o°F.  must 
be  borne  by  foundrymen,  while  a  temperature  of  —  75°F.  must  be 
endured  in  some  inhabited  parts  of  the  globe. 

From  this  it  is  seen  that  man  possesses  a  wide  range  of  adaptability 
(325°F.)  to  temperature  variation. 

The  atmosphere  is  capable  of  great  heat  absorption,  the  degree 
varying  in  different  regions  and  depending  upon: 

(a)  Latitude; 

(b)  Altitude; 

(c)  Season; 

(d)  Ocean  currents; 

(e)  Proximity  to  volcanoes  or  hot  springs; 
(/)  Wind; 

(g)  Proximity  to  man's  industrial  activities. 

Thermometer.— The  temperature  of  the  air  is  best  measured  by  the 
mercurial  thermometer.  This  should  be  made  after  the  pattern  of  the 
ore  inary  clinical  thermometer,  having  a  long  glass  bulb  filled  with 


Pm.  3. — A  properly  made  thermometer.     The   scale  is  etched   on  the  glass. 

mercury  at  the  lower  end  of,  and  continuous  with,  a  long  glass  tube, 
the  end  of  which  is  sealed.  The  cavity  of  the  bulb  and  the  lumen  of  the 
tube  are  continuous. 

As  with  the  clinical  thermometer  the  scale  should  be  etched  upon 
the  glass,  and  not  placed  upon  any  frame  or  backing.  .  Erroneous 
readings  readily  may  result  from  the  slipping  up  or  down  of  the 
mercury-containing  tube  upon  such  frame  or  backing,  consequently 
disturbing  the  correspondence  between  the  figures  on  the  scale  and  the 
height  of  the  mercury  column. 

Three  scales  are  used  in  grading  thermometers,  the  barometer  reading  760 
mUlim< 

i.  The  Fahrenheit  scale  which  places  zero  at  the  temperature  obtained  by  mixing 
equal  parts  of  sal  ammoniac  and  snow,  which  mixture  produced  the  lowest  known 
tempi-nature  when  the  scale  was  adopted  in  1714.  This  temperature  was  regarded 
as  absolute  zero.  The  temperature  of  melting  ice,  or  "freezing  point,"  on  the 
I •'.ihrenheit  scale  is  32°F.,  while  the  boiling  point  is  placed  at  2i2°F.  The  Fahren- 
heit scale  is  in  common  use  in  the  United  States,  England,  and  some  other  countries. 


i8 


NAVAL   HYGIENE 


2.  The  Centigrade  scale  (often  called  "Celsius"  after  its  inventor)  places  zero 
at  the  "freezing  point"  (32°F.)  and  its  boiling  point  is  100°.     The  temperature 
range  from  freezing  to  boiling  distilled  water  is  divided  into  100°  parts  or  degrees. 
This  Centigrade  scale  is  in  use  for  nearly  all  scientific  work  in  the  United  States  and 
abroad. 

3.  The  Reaumur  scale  places  its  zero  at  freezing  point  (32°F.  or  o°C.)  and  adopts 
80  as  its  boiling  point,  subdividing  the  range  from  freezing  point  to  boiling  point 
into  80  parts  or  degrees. 

From  the  foregoing  it  will  be  seen  that: 

Fahrenheit 

Boiling  point 2i2°F. 

Freezing  point 3-2°F. 

Therefore i8o°F. 

Therefore...  i°F. 


Centigrade 

ioo°C.  = 

o°C.  = 

ioo°F.  = 


R6aumur 
8o°R. 
o°R. 

8o°R. 


Rfaumur  [ff 
8fl!l 


Freezing 


FIG.  4. — A  sketch  showing  the  method  of  graduation  of  the  Fahrenheit,  Centi- 
grade and  Re"amur  thermometers  and  that  i8o°F.  equals  ioo°C.  and  8o°R. 

The  formula  for  converting  Fahrenheit  into  Centigrade  is  C.  =  (F.—  323)% 

e.g.,  u3°F.  =  (113°  -  32°)%,  or  8i°X%  =  45°C. 
The  formula  for  converting  Centigrade  into  Fahrenheit  is  F.  =  %°C. 

e.g.,  45°C.  =•  (45°  X  %)  +  32,°  or  81°  +  32°  =  ii3°F- 
Conversions  into  and  from  the  Reaumur  scale  may  be  similarly  made. 


AIR  IQ 

Lines  uniting  points  of  equal  temperature  on  the  earth's  surface 
are  called  isotherms. 

Physiology. — Effect  of  hot  and  cold  air  upon  the  body: 

Cold  air  stimulates  the  body  and  acts  as  a  tonic,  accelerating  meta- 
bolic change; 

Warm  air  depresses  the  body,  retarding  metabolism; 

Dry  air  is  tonic  and  stimulating; 

Moist  air  is  depressing. 

As  temperature  and  humidity  increase,  depression  increases,  and  at 
a  wet  bulb  temperature  of  85°F.  the  body  temperature  begins  to  rise 
owing  to  diminished  heat  loss  on  part  of  the  body,  even  though  it  be 
at  rest. 

Progressive  increase  of  temperature  and  humidity  will  result  in 
heat  stroke  at  a  temperature  far  below  that  which  can  be  borne  readily 
if  the  relative  humidity  be  low. 

Small  is  the  authority  for  the  statement  that  man  generates 
enough  heat  to  raise  his  body  to  the  boiling  point  (2i2°F.)  in  one  and 
one-half  days  if  no  body  heat  is  allowed  to  escape.  But  for  the 
kindly  offices  of  evaporation,  radiation,  and  conduction  we  should  all 
be  boiling  after  we  are  two  days  old. 

The  most  comfortable  temperature  for  man  is  from  65°F.  to  75°F. 
At  77°F.  the  temperature  commences  to  "feel  warm"  or  uncomfortable, 
hence  is  called  the  "critical  temperature.''' 

Mobility. — Heated  air  expands  and  rises  because  of  its  decreased 
density,  cooler,  heavier  air  rushing  in  to  fill  the  space  from  which  the 
heated  air  is  rising. 

Air  currents  are  thus  established.  When  in  nature  this  process 
occurs  on  a  large  scale  wind  is  produced.  Wind  is  air  in  motion. 

Practically  all  air  currents  except  those  produced  as  result  of 
man's  activities  are  due  to  temperature  differences.  The  wind  and 
air  currents  are  of  much  value  to  man  in  influencing  the  temperature 
of  his  environment;  removing  excessive  humidity;  bringing  to  him 
fresh  and  carrying  away  vitiated  air. 

Elasticity. — As  pure  air  is  a  mechanical  mixture  of  gases  it  follows 
the  physical  laws  governing  gases,  possesses  tension,  or  elastic  force; 
is  compressible  and  is  capable  of  liquefaction  under  low  temperature 
(— i90°C.)  and  at  atmospheric  pressure  (760  mm). 

Density  or  Weight. — Air  has  weight.  One  hundred  cubic  inches 
of  dry  air  weigh  31  grains. 


20  NAVAL   HYGIENE 

As  a  man  moves  at  the  bottom  of  the  air  ocean  he  sustains  the 
pressure  or  weight  of  a  column  of  air  extending  from  the  earth's  surface 
to  that  of  the  air  ocean,  and  having  an  area  in  horizontal  section  equal 
to  the  area  of  the  horizontal  section  of  the  man  at  the  same  level. 

This  amount  of  pressure  is  about  15  pounds  to  the  square  inch  of 
body  surface,  actually  14.64  pounds,  and  as  the  area  of  body  surface  of 
an  average  size  man  is  about  16  square  feet,  the  pressure  sustained 
by  an  individual  at  sea  level  approximates  16  tons. 

The  density  of  air  is  measured  by  the  barometer. 

The  Barometer. — If  a  glass  tube  about  34  inches  long,  closed  at  one  end,  be  filled 
completely  with  mercury  and  inverted  in  a  basin  of  mercury,  the  column  of  mercury 
within  the  tube  gradually  will  fall  until  it  reaches  a  point  where  it  remains  station- 
ary, being  exactly  balanced  by  a  column  of  air  extending  from  the  upper  limit  of 

the  air  ocean  to  the  level  of  the  lower  end  of  the 
column,  and  having  a  cross-sectional  area  identical 
with  that  of  the  column  of  mercury. 

The  height  of  this  column  at  the  sea  level  is  29.92 
inches  or  760  millimeters.  Depending  upon  the 
weight  of  the  air  column  will  be  the  weight  (and  of 
course  the  height)  of  the  mercury  column  which  it 
exactly  balances. 

Such  a  tube  filled  with  mercury,  inverted  in  a 
basin  of  mercury,  and  having  an  accurately  graduated 
scale  from  which  the  height  of  the  mercury  column 
may  be  read   is  called  a  Cistern  barometer,  Mer- 
curial barometer,  or  simply  barometer,  and  becomes 
pIG    - The  aneroid          for  us  a  direct  measure  of  weight  or  density  of  air,  ex- 
barometer,  pressed  in  terms  of  height  of  column. 

A  barometer  of  this  kind  is  in  daily  use  aboard 

ships,  and  at  the  Weather  Bureau's  observation  stations  for  use  in  determining 
atmospheric  pressure. 

Heated  air  becomes  lighter  and  rises,  cold  air  rushes  in  to  take  its  place.  Winds 
are  thus  formed.  So  the  barometer,  by  telling  us  whether  the  air  is  lighter  or  heavier 
than  normal,  gives  valuable  information  as  to  what  weather  conditions  may  be 
expected. 

Another  barometer,  useful  because  of  its  small  size  and  portability,  is  the  Aneroid 
barometer,  which  consists  of  a  thin -walled  metal  chamber  from  which  the  air  has 
been  exhausted  and  to  which  is  attached  an  index  or  pointer  registering  upon  a 
scale  the  degree  of  pressure  or  "squeeze"  exerted  by  the  atmosphere  upon  this  thin- 
walled  vacuum  chamber. 

The  scale  is  graduated  by  comparison  with  the  standard  mercurial  barometer, 
both  being  simultaneously  placed  under  the  receiver  of  an  air  pump  and  subjected 
to  various  pressures. 

Following  Boyle's  law  the  temperature  of  a  given  volume  of  air  remaining  the 
same,  the  volume  will  vary  inversely  with  pressure  it  bears. 


AIR  21 

E.g.,  the  temperature  remaining  the  same: 

1000  c.c.  of  air  equals  900  c.c.  at  33.24  inches  (mercurial  barometer) 
1000  c.c.  at  29.92  inches  (mercurial  barometer) 
1 100  c.c.  at  27.02  inches  (mercurial  barometer) 

For  purposes  of  accurate  estimation  in  volumetric  work  with  air 
all  specimens  are  considered  under  the  pressure  at  sea  level  or  are  con- 
verted to  that  pressure,  which  is  the  standard.  In  each  of  the  preced- 
ing examples  the  volumes  900  c.c.  and  noo  c.c.  would  be  reduced  to 
standard.  The  importance  of  these  variations  of  atmospheric  pressure 
is  emphasized  when  it  is  remembered  that: 

(a)  Mountain  sickness,  and  no  doubt  certain  accidents  to  aviators, 
are  due  to  rarefaction  of  atmosphere  as  result  of  altitude; 

(b)  Caisson  Disease. — "  Bends,"  and  diver's  palsy  are  conditions 
resulting  from  exposure  to  excessive  air  pressure  with  too  rapid  de- 
compression; and, 

(c)  Squeeze  may  cause  death  of  a  diver  as  result  of  inadequate 
pressure  of  air  delivered  within  the  diving  suit. 

Lines  uniting  points  of  equal  pressure  on  the  earth's  surface  are 
called  isobars. 

Humidity. — Moist  air  is  lighter  than  dry  air,  hence  moist  air  tends 
to  rise  above  dry  air  of  the  same  temperature.  This  physical  property 
of  air  results  in  air  currents  which  remove  heat  and  humidity  from  man. 

Humidity  will  be  further  discussed  under  "  Chemical  Composition 
of  Air." 

CHEMICAL  COMPOSITION 

is  a  mechanical  mixture  of  gases,  not  a  chemical  compound. 
The  chemical  composition  of  air  is  given  by  Rosenau  as: 

Oxygen 20. 94  per  cent,  by  volume 

Nitrogen 78.09  per  cent,  by  volume 

Carbon  dioxide 0.03  per  cent,  by  volume 

Argon o .  94  per  cent,  by  volume 

Helium Trace 

Krypton Trace 

Neon Trace 

Xenon Trace 

Hydrogen Trace 

Peroxide  of  hydrogen Trace 


22  NAVAL   HYGIENE 

Ammonium Trace 

Ozone Trace 

Gatewood  says  sea  air  contains : 

Nitrogen  (argon,  etc.) 77 . 90600 

Oxygen  (ozone) 20. 65955 

Water  vapor,  as  gas i .  40000 

Carbon  dioxide o .  03360 

Ammonia o .  00080 

Nitric  acid o .  00005 

The  average  percentage  of  water  vapor  in  sea  air  is  1.4  per  cent. 

From  a  hygienic  viewpoint  we  may  consider  the  components  of  air 
as: 

A.  Essential; 

B.  Non-essential. 

A.  The  essential  constituents  are  those  necessary  to  man's  welfare, 
yet  the  percentage  concentration  of  these  constituents  may  vary  to  an 
extent  sufficient  to  be  harmful  or  even  fatal  to  man. 

The  essential  components  are: 

1.  Oxygen; 

2.  Nitrogen; 

3.  Carbon  dioxide; 

4.  Aqueous  vapor.  I 

i.  Oxygen. — Oxygen  is  a  gaseous  element  necessary  to  all  known 

life.     Even  anaerobic  bacteria,  while  developing  better  under  exclusion 
of  atmospheric  air,  consume  oxygen,  obtained  through  cleavage 
carbohydrates  in  their  nutrient  media. 

Man  must  have  oxygen  constantly.  It  constitutes  20  per  cent, 
atmospheric  air  and  reduction  below  16  per  cent,  gives  distress,  below 
12  per  cent,  slow  death,  and  complete  deprivation  of  oxygen  for  five 
minutes  results  fatally  to  man. 

The  oxygen  percentage  of  the  atmosphere  must  vary  within  very 
narrow  limits  in  order  to  maintain  life  and  healthy  physiological 
processes. 

Oxygen  exists  in  the  air  under  a  partial  pressure  of  152  millimeters 
of  mercury  and  under  this  partial  pressure  enters  the  lungs,  unites  with 
the  haemoglobin  of  the  blood  to  form  a  readily  dissoluble  or  unstable 
compound — oxyhaemoglobin.  Oxygen  is  supplied  to  the  tissues  by  the 


JLL 

: 

of 


AIR 
breaking  down  of  the  oxyhaemoglobin. 

and  ultimately 

23 

is  discharged 

from  lungs  as  carbon  dioxide. 

0 

M 

C02 

HO» 

Inspired  air  contains  .  .  . 

.20.96 

79 

0.03 

X 

Expired  air  contains  .  .  . 

.16.02 

79 

4.38 

100 

4-94 

o 

4.35 

100 

It  will  be  seen  that  of  each  cubic  foot  of  air  inhaled  the  system 
appropriates  4.94  per  cent,  of  O  and  excretes  4.35  per  cent.  CC>2. 
The  excess  of  oxygen,  0.59  per  cent,  by  volume,  most  probably  is  ex- 
creted as  water  by  lungs,  skin,  or  kidney,  probably  the  former. 

2.  Nitrogen. — Nitrogen  belongs  to  the  indifferent  gases.     Exami- 
nation of  expired  air  shows  no  diminution  of  the  volume  of  nitrogen 
inspired. 

The  circulating  blood  shows  only  1.7  per  cent,  of  nitrogen  in  solu- 
tion. This  percentage  appears  constant  both  in  arterial  and  venous 
blood  and  suggests  that  the  nitrogen  in  the  blood  probably  is  not  of 
respiratory  origin. 

The  sole  function  of  nitrogen  in  the  atmosphere  appears  to  be  that 
of  a  diluent  preventing  the  untoward  effects  which  would  result  from 
too  great  concentration  of  oxygen. 

Nitrogen,  however,  is  largely  used  in  the  growth  of  plants,  which 
may  be  regarded  as  the  source  of  all  nitrogenous  foods  used  by  man, 
both  animal  and  vegetable. 

In  the  growth  of  plants  the  so-called  nitrifying  bacteria  play  an 
important  role,  forming  nodes  upon  the  roots  of  certain  legumes  and 
other  plants  used  for  food  by  man  or  by  animals  which  supply  milk 
and  meat  to  man.  These  nodes  aid  the  plant  in  absorbing  necessary 
nitrogen. 

3.  Carbon  Dioxide. — The  normal  percentage  of  carbon  dioxide  in 
air  is  0.03  per  cent,  by  volume.     Carbon  dioxide  is  constantly  present 
in  all  atmospheric  air  and  is  necessary  to  the  growth  of  vegetable  life. 

4.  Aqueous   Vapor. — The   atmosphere   contains    water    vapor   in 
amount  varying  from  zero  to  saturation  (100  per  cent.)  for  a  given 
temperature  and  pressure. 

Absolute  moisture  is  that  actually  present  in  a  volume  of  air. 

Saturation  is  that  condition  of  a  volume  of  air  when  it  contains  the 
maximum  possible  quantity  of  water  vapor. 

Saturation  deficit  is  the  weight  of  water  vapor  required  to  saturate 
a  tfiven  volume  of  air  minus  absolute  moisture. 


24  NAVAL   HYGIENE 

The  amount  of  water  vapor  in  a  given  volume  of  air  is  expressed  as 
a  percentage  of  the  amount  that  the  volume  of  air  could  hold  at  its 
temperature. 

This  percentile  expression  of  the  hygrometric  state,  or  approxima- 
tion to  saturation  with  water  vapor,  of  a  given  volume  of  air  at  its 
temperature  is  the  "relative  humidity"  of  that  air. 

Relative  humidity,  then,  is  a  term  expressing  the  percentage  of 
saturation  with  water  vapor  for  its  temperature  of  a  given  volume  of 
air. 

In  other  words: 

Weight  of  aqueous  vapor  actually  present  X  100 

Relative  humidity  = ,Tr~=~T^  * 

Weight  of  aqueous  vapor  it  could  contain 

E.g.,  the  weight  of  aqueous  vapor  in  a  cubic  foot  of  air  at  75°F.  is  9.39 
grains  when  the  air  is  saturated  for  its  temperature.  A  cubic  foot  of 
air  at  the  same  temperature,  75°F.,  and  containing  4.695  grains  of 

vapor  would  have  a  relative  humidity  of  -  -  =   50   per  cent. 

y°o  7 
R.  H. 

Aqueous  vapor  which  at  7o°F.  would  condense  into  fog,  snow  or 
rain  would  at  90°F.  show  a  clear  sky. 

The  amount  of  water  vapor  in  the  atmosphere  is  determined  by 
means  of  hygrometers,  which  may  be: 

(a)  Chemical    hygrometers; 

(b)  Condensing  hygrometers; 

(c)  Hair  hygrometers; 

(d)  Psychrometers. 

(a)  The  chemical  hygrometer  is  an  apparatus  which  enables  the  passing  of  a 
known  volume  of  air  through  a  definite  weight  of  an  hygroscopic  salt.  Increase 
in  weight  of  the  salt  measures  the  weight  of  water  vapor  present  in  the  volume  of 
air  from  which  the  moisture  has  been  extracted. 

(6)  The  condensing  hygrometer  is  an  apparatus  by  which  are  determined  the 
temperatures  at  which  moisture  is  deposited  upon  and  absorbed  from  a  metal  surface 
by  the  raising  and  lowering  of  atmospheric  temperature.  The  average  of  the 
temperatures  at  which  moisture  is  deposited,  and  that  at  which  it  disappears  as  the 
temperature  is  raised  is  known  as  the  "dew  point." 

(c)  The  hair  hygrometer  is  one  of  the  most  delicate  of  instruments  and  depends 
upon  the  expansion  of  a  strand  of  human  hair  as  result  of  absorption  of  moisture  and 
its  contraction  upon  drying.  The  degree  of  tension  resulting  from  the  expansion  or 
contraction  is  indicated  by  a  pointer  upon  a  standardized  scale.  Some  of  these 
instruments,  e.g.,  the  hygrophant,  are  ingenious  and  very  convenient  for  use  in 
determining  temperature,  relative  humidity,  etc. 


(d)  The   psychrometer,  or  wet  bulb  thermometer,  is  the  hygrometer  us 
the  United  States  Navy. 

Two  mercurial  thermometers,  one  of  which  has  its  bulb  covered  by  a  thin  cotton 
wick  which  extends  into  a  small  cup  of  distilled  water,  constitute  the  essential 
feat  ures  of  this  instrument. 

The  bulb  is  kept  constantly  wet  by  means  of  the  wick  which  draws  water  by 
capillary  attraction  from  the  cup.  Evaporation  from  the  wick  covering  the  wet 


6. — The  psychrometer  commonly  used  on  board  ship  for  determining  the 
degree  of  humidity  in  the  atmosphere. 

bulb  reduces  the  temperature  of  tin-  mercury  in  tin-  bulb,  consequently,  unless  the 
atmosphere  is  very  near  to  saturation  there  will  always  be  considerable  difference 
between  the  dry  bulb  thermometer  and  the  wet,  the  hitter  being  the  lower.  This 
difference  of  readings  indicates  the  condition  of  atmospheric  humidity.  If  the  wet 
bull)  is  as  high  as  the  dry  it  i-  evident  that  the  atmosphere  is  saturated  and  that 
as  the  vapor  is  already  at  maximum  tension,  no  evaporation  from  the  surface  of  the 
wet  bulb  can  take  place,  and  the  wet  and  dry  bulb  thermometers  register  alike. 


26 


NAVAL   HYGIENE 


If  the  air  be  very  dry  or  thirsty,  evaporation  from  the  wet  bull:  will  be  rapid,  cooling 
of  the  bulb  will  take  place,  and  the  wet  bulb  thermometer  may  register  several 
degrees  below  the  dry  bulb.  The  difference  between  the  dry  and  wet  bulb  thermo- 
meters indicates  the  degree  of  tension  of  the  aqueous  vapor  in  the  air. 

Humidity  tables  accompany  the  instrument  and  from  them  one  may  ascertain 
the  percentage  of  saturation  (relative  humidity)  for  the  temperature  registered  by 
the  dry  bulb. 

RELATIVE  HUMIDITY  TABLE. 

TABLE  OF  R.  H.  COMPUTED  FROM  D.  B. — W.  B.  OF  STATIONARY  PSYCHROMETER. 


Temp, 
dry 
bulb 

Fahr. 

Difference  between  dry  and  wet  bulb 

i 

2 

3 

4 

s 

6 

7 

8 

9 

10 

ii 

12 

13 

14 

IS 

Relative  humidity  at  saturation  =  100 

QO 

95 

90 

85 

81 

77 

73 

69 

65 

62 

59 

56 

153 

50 

47 

44 

89 

95 

90 

85 

81 

77 

73 

69 

65 

61 

58 

55 

52 

49 

46 

43 

88 

95 

90 

85 

81 

77 

73 

69 

65 

61 

58 

55 

'52 

49 

46 

43 

87 

95 

90 

85 

81 

77 

73 

69 

65 

61 

58 

55 

> 

49 

46 

43 

86 

95 

90 

85 

80 

76 

72 

68 

64 

61 

58 

55 

52 

49 

46 

43 

85 

95 

90 

85 

80 

76 

72 

68 

64 

61 

58 

55 

52 

49 

46 

43 

84 

95 

90 

85 

80 

76 

72 

68 

64 

60 

57 

54 

5i 

48 

45 

43 

83 

95 

90 

85 

80 

76 

72 

•68 

64 

60 

57 

54 

5i 

48 

45 

42 

82 

95 

90 

85 

80 

76 

72 

68 

64 

60 

57 

54 

Si 

48 

45 

42 

81 

95 

90 

85 

80 

76 

72 

'68 

64t 

60 

5-6 

53 

50 

47 

44 

4r 

80 

95 

90 

85 

80 

75 

7i 

67 

59 

56 

53 

-5o 

47 

44 

4' 

79 

95 

90 

85 

80 

75 

7i 

67 

63 

59 

56 

53 

So 

47 

44 

4i 

78 

94 

89 

84' 

79 

75 

7i 

67 

63 

59 

56 

53 

•5° 

47 

44 

4i 

77 

94 

89 

84 

79 

75 

7i 

67 

63 

59 

56 

53 

.50 

47 

44 

4i 

76 

94 

89 

84 

79 

75 

7i 

67 

63 

59 

55 

52 

'49 

46 

43 

40 

75 

94 

89 

84 

79 

74 

70 

66 

62 

58 

55 

52 

49 

46 

43 

40 

74 

94 

89 

84 

79 

74 

70 

66 

62 

58 

55 

52 

48 

45 

43 

40 

73 

94 

8Q 

84 

79 

74 

70 

66 

62 

58 

54 

5i 

48 

45 

42 

40 

72 

94 

89 

84 

79 

74 

69 

65 

6r 

57 

54 

5i 

48 

45 

42 

39 

7i 

94 

88 

83 

78 

73 

69 

65 

61 

57 

53 

5o 

47 

44 

4i 

38 

70 

94 

88 

83 

78 

73 

69 

65 

61 

57 

53 

5o 

47 

44   4i 

38 

69 

94 

88 

83 

78 

73 

68 

64 

60   56 

53 

5o 

47   44   41 

38 

68 

94 

.88 

83 

78 

73 

68 

64 

60   56 

52   49 

46 

43   40 

37 

67 

94 

88 

83 

78 

73 

68 

64 

60 

56 

52 

49 

46 

43   40 

37 

66 

94 

88 

83 

78 

73 

68 

64 

60 

56 

52 

48   45 

42 

40 

37 

65 

94 

88   83 

78 

73 

68 

63 

59 

55 

5i 

48   45 

42 

39 

36 

64 

94 

88   82 

77 

72 

67 

63 

59 

55 

5i 

48   45   42   39 

36 

63 

94 

88   82 

77 

72 

67 

63 

59 

55   51   47   44   41   38 

35 

62 

94 

88 

82   77 

72 

67 

62 

58 

54   50 

47   44   41   38 

35 

61 

94 

88 

82 

77 

7* 

67 

62 

58 

54   50 

47 

44   41   38 

35 

RELATIVE  HUMIDITY  TABLE.  -Continued. 

TAHLK  OF  R.  II.  COMIM  TKD  FROM  I).  B. — W.  B.  OF  STATIONARY  PSYCHROMETER. 


Temp, 
dry 
bulb 

Fahr. 

Difference  between  dry  and  wet  bulb 

. 

10 

ii 

12 

13 

14 

IS 

Relative  humidity  at  saturation  =  100 

60 

94 

88 

82 

76 

7i 

66   62   58   54   50  46   43   40 

37 

34 

59 

94 

88 

82 

76 

7i 

66 

61   57   53   49 

46 

43 

40 

37 

34 

58 

93 

87 

81 

76 

7i 

66 

61 

57 

53 

49 

46 

43 

40 

37 

34 

57 

93 

87 

81 

75 

70 

65 

61 

57 

53 

49 

45 

42 

39 

36 

33 

5<5 

93 

87 

81 

75 

70 

65 

60 

56 

52 

48 

44 

41 

38 

35 

32 

55 

93 

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The  sling  psychrometer  is  ;in  instrument  similar  to  the  psychrometer  just 
described  except  that  it  has  a  strong  handle  to  which  is  attached  the  part  which 
moves  and  carries  the  thermometer. 

By  appropriate  motion  tin-  moving  member  whirls  around  the  handle,  causing 
more  rapid  evaporation  from  the  wet  bulb  thermometer,  and  in  a  few  moments 
the  readings  may  be  taken,  i.e.,  just  so  soon  as  the  mercury  in  each  thermometer 
takes  its  stand,  no  longer  rising  or  falling. 

This  instrument   is  convenient   because  of  its  portability  and  easy  use.     The 


28 


NAVAL   HYGIENE 


FIG.   7. — A  sling   psy- 


above- mentioned  humidity  tables 
are  necessary  to  determination  of 
relative  humidity  by  means  of  this 
instrument. 

At  sea  the  relative  humid- 
ity of  the  air  is  greater  than 
ashore.     This    depends    upon    several    factors, 
chief  among  which  are  temperature,  latitude, 
and  winds. 

The  chief  sources  of  aqueous  vapor  in  the 
atmosphere  are: 

(a)  Evaporation  of  water  from  the  earth's 
surface; 

(b)  Evaporation  from  the  leaves  of  plants; 

(c)  Evaporation  from  skins  and  exhalation 
from  lungs  of  man  and  animals; 

(d)  Combustion; 

(e)  At  sea,  action  of  winds  and  waves. 

(a)  The  action  of  the  sun  upon  the  oceans, 
rivers,    and   all  water  on  the  earth's  surface 
causes   a  degree   of  evaporation  proportionate 
to  temperature. 

(b)  Enormous  amounts  of  water  vapor  are 
given  off  from  the  leaves  of  growing  plants. 
Hellriegel  estimated  that  for  each  pound  of  dry 
vegetable  matter  325  pounds  of  aqueous  vapor 
have  been  discharged  into  the  air. 

(c)  From    Skin   and   Lungs   of  Man   and 
Animals. — Foster  estimates  that  an  adult  man 
gives  off  about  4  pounds  of  water  daily  from 
skin  and  lungs.     Gate  wood  (Naval  Hygiene,  p. 
192)  states  that  a  crew  of  800  men  at  rest  would 
be  excreting  1600  pounds  of  water  from  the  skin 
in   twenty-four  hours.     This  same  crew  would 
be  exhaling  from  the  lungs  at  least  500  pounds 
of  water  daily  (Pettenkofer  and  Voit  estimate  TO 
ounces   of   water   daily  from   lungs   of  adult). 


chrometer.      (From  Gate-     Consequently    a    crew    of  800  men  would  be  CX- 


wood.) 


AIR 


creting  at  least  2100  pounds  per  day  of  water  as  aqueous  vapor  from 
skin  and  lungs. 

(d)  Combustion  results  in  formation  of  considerable  water  vapor, 
especially  in  the  vicinage  of  cities  where  industrial  activities  contribute 
no  small  amount. 

(e)  Wind  and  waves  at  sea  tend  to  throw  much  water  vapor, 
and  fine  globules  of  water  in  suspension  as  well,  into  the  air,  thus 
rendering  the  air  very  moist  at  sea  and  for  some  distance  inland. 

B.  The  non-essential  constituents  and  pollutions  of  the  air  are 
many  and  are: 

1.  Gaseous; 

2.  Particulate. 

.  The  gaseous  non-essential  constituents  are: 

(a)  Non-poisonous; 

(b)  Poisonous. 

(a)  The  principal  non- poisonous  gases  are: 

1.  Ozone; 

2.  Peroxide  of  hydrogen; 

3.  Argon; 

4.  Neon; 

5.  Xenon; 

6.  Krypton; 

7.  Coronium  and  helium. 

Ozone  and  peroxide  of  hydrogen  are  of  more  or  less  accidental 
occurrence  in  the  air  and  are  believed  to  be  chiefly  the  result  of  elec- 
trical discharge  in  the  atmosphere.  These  two  gases  possess  such  great 
oxidizing  power  that  they  soon  spend  themselves  in  oxidation  of 
organic  matter  in  the  atmosphere,  consequently  they  exist  in  a  free 
Mate  but  a  very  short  time. 

One  part  of  ozone  per  million  in  the  atmosphere  is  irritating  to  the 
mucous  membranes  (Hill  and  Flack),  while  15  parts  per  million  is 
very  dangerous  to  life  if  inhaled  for  a  period  of  two  hours.  Hence  the 
expression  "breathing  the  pure  ozone"  is  misleading,  for  "the  pure 
ozone"  is  really  a  poison. 

Argon,  helium,  neon,  krypton,  xenon,  and  coronium  occur  in 
minute  quantities  in  the  atmosphere,  are  usually  included  in  the 
nitrogen  percentage  of  atmosphere,  and  are  inert  scientific  curiosities 
from  the  viewpoint  of  the  hygienist. 


30  NAVAL  HYGIENE 

(b)  The  principal  poisonous  gases  found  in  the  air  are : 

1.  Carbon  dioxide  (CO2); 

2.  Carbon  monoxide  (CO) ; 

3.  Ammonia  (NH3); 

4.  The  nitrogen  gases. 

i.  Carbon  dioxide  is  one  of  man's  excretions.  He  cannot  utilize  it. 
Since  man  inhales  0.03  per  cent,  by  volume  at  each  inhalation  and 
exhales  4.38  per  cent,  at  each  exhalation,  more  than  one  hundred  times 
as  much,  it  would  appear  that  the  normal  CC>2  constituent  of  air  is 
negligible  in  its  effect  upon  man. 

Carbon  dioxide  reaches  the  air  from : 

(a)  Vital  processes  of  plants; 

(b)  Expired  air  from  man  and  animals; 

(c)  Fermentation  processes  in  nature; 

(d)  Chemical  changes  in  nature; 

(e)  Combustion  and  industrial  activity; 

(/)  Charged  mineral  springs  and  probably  from  combustion  in  the 
earth's  interior. 

In  an  atmosphere  containing  4  per  cent,  by  volume  of  carbon  diox- 
ide, i.e.,  in  concentration  about  equivalent  to  that  of  expired  air, 
discomfort  soon  commences  to  be  felt  if  the  oxygen  percentage  has  been 
correspondingly  reduced  and  considerable  irritation  of  the  respiratory 
center  is  evidenced. 

When  the  concentration  of  carbon  dioxide  reaches  10  per  cent,  the 
pulse  and  respiration  are  greatly  accelerated  and  consciousness  begins 
to  fail. 

Experimental  animals  can  live  in  CO2  concentration  of  25  per  cent, 
if  the  oxygen  percentage  be  increased  to  30  or  40  per  cent. 

It  will  be  observed  that  there  is  a  wide  range  of  percentile  concen- 
tration of  CO2  in  air  (0.03  to  4  per  cent.)  which  man  may  bear  without 
discomfort. 

As  air  normally  contains  0.03  per  cent,  by  volume  of  CC>2,  excess  of 
this  amount  must  be  regarded  as  further  pollution  due  to  respiration, 
combustion,  etc.  It  appears  to  be  the  consensus  of  opinion  of  investi- 
gators that  when  the  concentration  of  CO2  has  reached  0.06  to  0.07  per 
cent,  in  occupied  spaces,  the  increased  temperature,  humidity,  emana- 
tions from  skins,  clothing,  respiratory  tract  and  alimentary  canal, 
will  have  so  vitiated  the  air  that  it  may  be  breathed  no  longer  without 
deleterious  effect,  despite  the  fact  that  the  CO2  percentage  is  very 


AIR  31 

small  when  compared  with  the  concentration  of  the  gas  which  man 
comfortably  may  breathe  without  harm. 

Temporarily  he  may  withstand  a  much  higher  concentration,  e.g., 
men  in  breweries  often  work  in  an  atmosphere  containing  10  per  cent. 
C()2  to  25  per  cent.  CO2. 

There  is  seldom  sufficient  CO2  in  the  air  to  produce  effect  dangerous 
to  life,  for  the  air  of  inhabited  spaces  becomes  intolerable  long  before 
even  an  uncomfortable  concentration  of  CO2  is  present.  Prolonged 
exposure  to  high  concentration  of  this  gas  may  result  in  a  lowering  of 
vitality. 

Estimation  of  the  percentage  volume  of  CO2  serves  as  a  guide  or 
index  to  tell  us  that  the  air  has  become  noxious,  not  because  of  the  con- 
centration of  COz,  btit  from  other  causes  accompanying  the  CO2. 

Formerly  CO2  was  regarded  as  the  cause  of  the  " closeness"  and  un- 
pleasant odor  in  occupied  rooms,  and  its  estimation  was  considered  ex- 
liTinely  important. 

More  recent  investigation  shows  undue  significance  has  been  given 
to  the  CO2  content  of  the  air,  and  hygienists  feel  that  an  estimation 
of  CO2  in  air  is  relatively  unimportant  and  of  scant  value  except  as  an 
index  to  the  degree  of  other  pollutions  in  expired  air. 

2.  Carbon  Monoxide. — This  is  a  dangerous  and  powerful,  odorless, 
colorless,  tasteless  gas  often  found  in  inhabited  places  and  is  commonly 
due  to  imperfect  combustion  of  coal  gas. 

In  a  recent  study  of  the  conditions  under  which  some  of  the  cloak,  suit,  dress, 
and  waist  makers  work  in  New  York  City,  the  United  States  Public  Health  Service 
found  the  air  in  n.8  per  cent,  of  the  shops  examined  showed  an  excessive  carbon 
monoxide  content.  The  condition  was  attributed  principally  to  defective  irons  used 
for  pressing,  or  to  defective  rubber  tubes.  Red-hot  iron  possesses  the  power  of 
absorbing  carbon  monoxide  and  giving  it  off  to  the  surrounding  atmosphere. 

K  i' rose  IK-  lamps  and  leaky  gas  pipes  supply  their  share  of  this  gas 
to  the  air.  Cold  objects  when  thrust  into  a  coal-gas  flame  cause 
incomplete  combustion  of  the  gas  and  CO  is  formed. 

Grehant  says  OIK-  gram  of  burning  tobacco  gives  off  82  c.c.  of  CO.  This  may 
explain,  in  part,  the  ill-lVrlinij  rxprrinu v<l  by  persons  who  have  spent  several  hours 
in  air  vitiated  by  burned  tobacco. 

Imperfect  combustion  in  gasolene  engines  may  cause  generation  of 
CO  to  a  dangerous  degree  in  improperly  ventilated  spaces.     Poisoning 
from  this  cause  has  been  reported  often  enough  to  warrant  unusual 
•    precautions  in  ventilating  garages  and  motor  boats. 


32  NAVAL  HYGIENE 

Carbon  monoxide  in  the  air  in  proportion  of  0.25  per  cent,  by  vol- 
ume will  cause  poisoning  and  i  per  cent,  proves  rapidly  fatal  to  animals. 
A  death  due  to  carbon  monoxide  poisoning  occurred  recently  in  the 
radio  room  of  one  of  our  destroyers.  The  gas  had  been  generated  by 
a  charcoal  brazier  used  for  heating  the  confined  space,  and  the  operator 
was  overcome  before  its  presence  was  known. 

3.  Ammonia.— Ammonia  is  a  constant  component  of  air,  usually 
found  in  traces,  but  often  in  considerable  concentration  as  result  of 
decomposition  of  nitrogenous  organic  matter. 

4.  Nitrogen  Gases. — The  nitrogen  gases  ^Os  and  N2Os  are  found 
in  small  quantity  in  the  air  as  result  of  action  of  ozone  upon  decompos- 
ing nitrogenous  substances  and  also  as  result  of  direct  chemical  union 
of  N  and  O  in  the  atmosphere  following  electrical  discharge. 

Sewer  Gas. — Because  of  its  disagreeable  odor,  sewer  gas  long  has 
been  regarded  as  productive  of  disease  in  some  vague  manner.  As  a 
matter  of  fact  workers  in  sewers  appear  to  have  no  greater  morbidity 
or  mortality  percentage  than  men  of  their  class  in  other  kinds  of 
employment. 

It  seems  probable  that  vermin  (rats,  insects,  etc.),  from  sewers 
constitute  a  far  greater  menace  to  man  than  sewer  air  which  long  has 
been  heartily  condemned. 

Infectious  material  flowing  in  a  well-aired  sewer  is  apt  to  be  con- 
veyed to  man  only  by  contact,  through  activities  of  rats  and  insects. 
It  is  highly  improbable  that  the  air  has  much  to  do  with  spread  of 
disease  from  sewers. 

Other  gaseous  impurities,  e.g.,  H^SC^HaSOs^Sa,  etc., resulting  from 
industrial  activities  are  found  in  the  air,  and  in  certain  localities  their 
concentration  is  so  great  as  to  blast  vegetation,  and  prove  dangerous 
to  persons  in  the  vicinage. 

Kenotoxin  or  Anthropotoxin.— For  years  some  have  held  that  there 
is  a  specific  protein,  probably  volatile,  poison  in  respired  air  which  is 
responsible  for  the  lassitude,  fatigue,  and  discomfort  felt  in  crowded 
spaces,  and  isolation  of  such  hypothetical  poison  has  been  attempted 
invariably  with  negative  results. 

It  has  been  shown  conclusively  that  increased  temperature  and 
increased  humidity  are  the  essential  factors  in  producing  this  discom- 
fort, and  that  mere  agitation  of  the  same  air  will  render  comfortable 
the  previously  close  room. 

The  work  on   this  subject  of  Pflugge  of  Breslau  has  attracted 


AIR  33 

much  attention  and  has  authoritative  confirmation.  He  made  a 
series  of  observations  upon  sick,  well,  young,  old,  clean  and  unclean 
persons  in  air-tight  glass  cabinets,  under  varying  conditions  of  tempera- 
ture, pressure  and  relative  humidity. 

It  was  found  that  these  persons  when  subjected  to  temperature 
55°F.,  relative  humidity  66,  and  CO-2  115  parts  per  10000,  after  three 
hours  and  five  minutes  suffered  no  ill  effects,  but  showed  discomfort 
with  temperature  of  8o°F.,  and  moderate  humidity;  while  with  tem- 
perature of  7o°F.  and  high  relative  humidity  all  exhibited  signs  of 
distress. 

This  distress  was  relieved  by  starting  a  fan,  not  by  admission  of 
fresh  air,  not  by  reducing  the  temperature  in  the  cabinet,  not  by  reduc- 
ing the  relative  humidity,  but  merely  by  starting  a  fan.  The  fan 
agitated  the  air  and  caused  increased  evaporation  from  body  surface, 
giving  additional  comfort  because  of  the  cooling  effect  of  the  air  currents 
set  up  by  the  fan. 

In  other  words,  when  the  temperature  and  relative  humidity  were 
so  high  as  to  prevent  radiation  of  heat  constantly  produced  by  the 
body,  nausea  and  distress  were  felt,  although  in  the  lower  temperature 
and  relative  humidity  the  subject  breathed  regularly  without  ill  effect, 
nearly  twice  as  much  CC>2  as  has  been  regarded  safe  (nearly  400  times 
the  amount  of  CC>2  contained  normally  in  the  atmosphere). 

IMlugge  found  that  with  their  bodies  within  air-tight  cabinets,  under 
high  temperature  and  relative  humidity,  but  breathing  fresh  air  great 
distress  still  was  felt  by  the  subjects.  Surely  here  the  CO2  could  not 
be  charged  with  producing  the  severe  constitutional  symptoms 
exhibited. 

Reversing  the  process  he  placed  the  bodies  outside  the  cabinet,  but 
caused  the  subjects  to  breathe  CC>2  130  parts  per  10,000  (1.3  per  cent.) 
and  no  deleterious  symptoms  were  observed.  Lastly  he  experimented 
up<>n  children  and  adults,  subjects  of  nephritis,  heart  disease,  bron- 
chitis, and  aiKumia,  in  his  cabinets  with  COa  at  150  parts  per  10,000 
(1.5  per  cent.),  temperature  7o°F.  and  relative  humidity  not  over  50. 
\<>  evil  effects  were  shown  but  they  promptly  appeared  when  the 
temperature  was  raised  to  80°  and  the  relative  humidity  was  increased, 
di-(«»mfort  being  proportionate  to  the  increases  in  temperature  and 
relative  humidity,  the  CO2  percentage  remaining  constant. 

The  experiments  of  Hill,  Rowland  and  Walker  are  of  interest.     An  air-tight 
ch;>  mber  of  2  cubic  meters  capacity,  containing  an  electric  fan,  but  having  no  ven- 
3 


34  NAVAL  HYGIENE 

tilation,  was  used  as  a  test  cabinet.  Occupation  of  the  cabinet  resulted  in  a  dry 
bulb  temperature  of  87°F.,  wet  bulb  83°F.,  a  CO2  concentration  of  5.25  per  cent, 
and  a  reduction  of  oxygen  to  15.1  per  cent,  in  forty-four  minutes.  Under  these 
conditions  great  discomfort  was  felt,  immediate  relief  was  obtained  by  start- 
ing the  fan  and  occupants  of  the  cabinet  cried  out  for  the  fan  when  it  was 
stopped. 

Another  interesting  experiment  by  the  same  observers  is  worthy  of  attention. 
Two  men,  subject  and  observer,  were  placed  in  the  cabinet,  which  was  heated  by  an 
electric  heater  and  the  air  humidified  until  the  wet-bulb  thermometer  registered 
85°F.  The  subject  inhaled  through  a  soda-lime  mixture  and  exhaled  through  an 
air  meter  so  that  only  traces  of  COa  could  be  inhaled.  Even  thus  the  subject's 
temperature  and  pulse  rose  although  he  was  not  even  breathing  the  small  amount 
(0.03  per  cent.)  of  CC>2  normally  contained  in  the  air.  When  the  fan  was  started 
his  discomfort  ceased,  and  pulse  rate  fell. 

Secretly  CO2  was  admitted  to  the  chamber  until  a  concentration  of  2  per  cent 
was  reached.  This  was  not  noticed  by  the  subject.  His  discomfort  was  due  to 
increased  temperature  and  humidity  within  the  cabinet,  which  was  relieved  by  the 
starting  the  fan,  while  the  concentration  of  CO2  was  unnoticed! 


It  appears  that  stoppage  of  heat  radiation  as  result  of  high  tempera- 
ture and  relative  humidity  is  more  dangerous  to  man  than  any  proba- 
ble pollution  by  CO2. 

Recent  research  has  resulted  in  a  radical  change  of  opinion  con- 
cerning the  importance  of  the  role  of  C02  in  respired  air,  and  it  seems 
that: 

1.  One  hundred  parts  per  10,000  (i  per  cent.  CO2)  is  harmless; 

2.  Agitation  of  air  in  confined  spaces  is  very  important; 

3.  Reduction  of  temperature  and  relative  humidity  usually  will 
reduce  discomfort  of  persons  in  closed  spaces  even  though  CO2  be 
above  i  per  cent. 

Benedict  and  Milner  have  shown  that  if  temperature  and  relative 
humidity  are  comfortable  the  CO2  content  of  air  practically  may  be 
disregarded. 

It  is  "erroneous  and  unscientific  to  rely  upon  determination  of  CO2 
in  air  of  a  room  as  a  measure  of  its  condition  for  respiration." 

If  chemical  methods  are  to  be  depended  upon,  is  it  not  more  rational 
to  determine  an  oxygen  minimum  instead  of  a  CO2  maximum  as  our 
gauge  of  respirability  of  a  given  volume  of  air? 

Other  gaseous  impurities  occur  in  air  as  result  of  man's  activities, 
animal  life,  chemical  decompositions,  and  bacterial  action.  These 
are  usually  unimportant  and  too  numerous  to  mention. 


AIR  35 

PARTICULATE  BODIES 

1 'articulate  bodies  are: 

1.  Inorganic: 

(a)  From  the  earth's  surface; 

(b)  From  meteoric  dust; 

(c)  From  activities  of  man  and  animals. 

2.  Organic: 

(a)  Dead; 

(b)  Living. 

1.  Inorganic  particulate  matter  of  almost  any  kind  may  be  swept 

(a)  from  the  earth's  surface  into  the  air.     Weathering  of  earth's 
surf.ice,   chemical   action   and   combustion   supplemented   by   man's 
activities  are  potent  factors  of  dust  production. 

(b)  Meteoric  dust  may  be  present  in  the  air. 

(c)  If   the  inorganic  dust   resulting  from  industrial  activities  be 
poisonous,  acute  or  chronic  specific  poisoning  may  occur,  as  in  lead 
poisoning,  arsenic  poisoning,  etc. 

If  the  inhaled  dust  be  not  an  active  poison  the  result  is  a  chronic 
irritation  of  the  respiratory  tract  which  may  go  on  to  pneumonia,  as  seen 
in  miners,  stone-cutters,  glass  polishers,  cutters  of  precious  stories,  etc. 

Dust  is  important  to  man  in  that  its  suspension  in  the  air  causes 
diffusion  of  sunlight,  prevents  shadows,  etc.,  and  the  dust  particles 
form  nuclei  for  formation  of  fog  and  rain. 

2.  Organic  particulate  matter  (living  pathogenic  germs)  adhering 
to  inorganic   dust  may  produce  the  specific  diseases  caused  by  those 
germs.     Organic  particulate  matter  may  be: 

(a)  Dead,  or 

(b)  Living. 

(a)  Dead. — Under  this  class  may  be  placed  detached  particles  from 
plants  and  the  animal  kingdom,  including  man,  also  minute  plants 
ami  animals  no  longer  possessing  life. 

Hair,  epithelial  cells,  and  extinct  microorganisms  are  examples 
of  this  class. 

(b)  Living.     In  this  extremely  important  class  fall  the  pathogenic 
an<   non-pathogenic  bacteria,  pollen,  insects,  and  such  microorganismal 
animal  life  as  may  lu-  >wept   up  from  the  earth's  surface  by  air  cur- 
rcnts  or  sprayed  into  the  air  as  minute  globules  of  sputum,  excreta, 
se\\age,  etc.     It  is  apparent  that  air  pollution  with  dust  or  particulate 


36      .  NAVAL  HYGIENE 

bodies  is  apt  to  occur  near  factories  and  that  the  variety  of  such  pollu- 
tion and  diversity  of  effect  is  too  great  for  our  consideration  here. 

Bacteriology.— Experiments  have  shown  that  at  an  elevation  of 
6300  feet,  the  atmosphere  is  free  of  bacterial  life.  Fisher  has  shown 
that  sea  air  120  miles  from  land  is  sterile.  The  air  of  cities  contains 
thousands  of  bacteria  per  cubic  centimeter,  while  that  of  the  country 
seldom  contains  100  organisms  per  cubic  centimeter. 

In  suburban  districts  the  outdoor  air  contains  from  fifty  to  one 
hundred  bacteria  per  cubic  foot  which  will  develop  at  2o°C.,  while 
only  about  half  the  number  would  develop  at  37°C. 

Mouth  streptococci  appear  to  be  about  twice  so  numerous  indoors 
(20  to  40  per  100  cubic  feet)  as  in  outdoor  air  in  suburban  districts. 
Air  plays  a  far  less  important  role  in  the  spread  of  transmissible  disease 
than  originally  was  attributed  to  it. 

The  microscope  has  proved  the  air  to  be  innocent  of  spreading 
certain  dread  diseases  formerly  considered  air-borne,  and  under  the 
searchlight  of  modern  scientific  investigation  scrupulous  disinfection 
of  excreta,  linen,  dishes,  cups,  forks,  spoons,  bath  water — indeed 
everything  that  comes  in  actual  contact  with  the  patient — has  stripped 
the  bogey  "air-borne  disease"  of  most  of  its  horror,  and  caused  neces- 
sity for  terminal  disinfection,  to  appear  unnecessary  except  as  source 
of  comfort  to  the  layman  who  has  been  accustomed  to  the  incon- 
venience of  fumigation. 

Rosenau  says  "  the  communicable  diseases  are  not  conveyed  in  the  air 
from  ward  to  ward  or  even  from  bed  to  bed  in  well-managed  hospitals. " 

Bacillus  prodigiosus  has  been  found  by  Hutchinson  to  be  transported 
by  sputum  droplets  for  a  distance  of  2000  feet  when  the  temperature 
is  not  sufficiently  high  to  dry  rapidly  the  droplets  and  kill  the  organisms. 

Chausse  (Nouvelles  Recherches  sur  la  Contagion  de  la  Tuberculose 
par  1'Air  Expire  pendant  la  Toux,  Annales  Institute  Pasteur  Vol.  xxx, 
No.  n,  p.  612)  and  Catheryn  V.  Riley  ("Observations  in  Baltimore," 
John  Hopkins  University,  1915)  have  given  us  very  recent  studies  con- 
cerning the  presence  in  air  of  living  and  possible  pathogenic  organisms. 

The  work  of  Chausse  gives  very  striking  demonstration  of  readiness 
with  which  droplet  infection  may  occur. 

While  air  per  se  seldom  contains  gaseous  pollution  sufficient  to  cause 
disease,  it  may  carry  in  suspension  dust  (glass  cutting,  etc.),  microorgan- 
isms (droplets  in  tuberculosis,  etc.),  insects  (mosquitoes,  etc.)  which 
cause  disease  in  man. 


CHAPTER  VI 
AIR  ABOARD  SHIP 

Ships  at  sea  a  distance  of  100  miles  from  the  shore  are  in  an  atmos- 
phere which  is  practically  dust-free  and  free  of  bacteria,  i.e.,  they  are  in 
an  atmosphere  of  exceptional  purity,  and  unpolluted  except  by  ships 
themselves. 

In  ports  the  ships,  of  course,  have  the  same  air  as  the  locality  m 
which  they  lie  and  this  may  be  even  offensive.  When  ships  lie  in  dry 
clocks — especially  in  warm  weather — and  the  animal  and  vegetable 
material  scraped  from  the  hull  decomposes,  or  when  ships  lie  in  prox- 
imity to  sewers  or  manufacturing  plants,  the  air  may  be  disagreeable, 
and  when  near  certain  industrial  plants  may  be  dangerous.  At  sea 
pure  air  enters  the  ship,  but  it  is  modified  there  and  polluted  according 
to  existing  conditions. 

The  pollutions  of  air  aboard  ship  are: 

i.  Gaseous; 
Particulate. 

i.  THE  PRINCIPAL  GASEOUS  POLLUTIONS 

>rincipal  gaseous  pollutions  are: 

(a)  Gases  from  respiration  and  combustion; 

(b)  Aqueous  vapor; 

(c)  Gases  from  stored  powder; 
( iases  from  gun  fire; 

(e )  Gases  from  stored  coal ; 

(/)  Gases  from  gasolene  and  c  leaning  and  polishing  materials; 

(g)  Gases  from  decomposition: 

1.  Bilges; 

2.  Torpedo  drainage  tanks; 

3.  Food  stuffs; 

4.  Water; 

(h)  Gases  from  turpentine  and  paint; 

37 


38  NAVAL   HYGIENE 

(i)  Gases  from  water  closets,  latrines,  and  scuppers; 
(7)  Gases  from  storage  batteries; 
(k)  Intestinal  gases. 

Air  exchange  through  walls  of  buildings  on  shore  is  a  well-recog- 
nized fact. 

No  transpiration  occurs  through  the  sides  of  a  modern  ship.  Air 
exchange  may  occur  through  hatches,  air  ports,  voice  tubes,  ammuni- 
tion hoists,  elevator  shafts,  but  otherwise  we  must  regard  a  steel  ship 
as  an  air-tight,  water-tight  vessel,  in  which  men  are  exhaling  daily 
large  quantities  of  COz  and  water  vapor. 

The  crew  live  as  if  at  the  bottom  of  a  bottle  through  the  mouth  of 
which  the  air  supply  must  come  and  all  foul  air  be  removed. 

(a)  The  carbon  dioxide  comes  principally  from  respiration  and 
combustion  of  fuel  for  generation  of  power.     Electric  lighting  results 
in  no  pollution  of  air  from  the  necessary  illumination  of  the  ship. 
Formerly  the  use  of  candles,  oil  lamps,  etc.,  resulted  in  great  vitiation 
of  the  air  on  board  ship. 

(b)  Aqueous  vapor  comes  from: 

1.  Respiration  and  perspiration  of  the  crew  (this  would  amount 
to  more  than  a  ton  of  water  daily  in  case  of  a  crew  numbering  eight 
hundred) ; 

2.  Escaping    steam; 

3.  The  washing  of  clothing,  persons,  dishes,  bulkheads  (walls), 
and  decks; 

4.  Cooking; 

5.  Evaporation  from  decks  wet  by  reason  of  shipping  seas  (waves 
coming  on  board)  in  heavy  weather;  and  last,  but  not  least— 

6.  The  relative  humidity  of  the  air  in  which  the  ship  is  lying. 

(c)  Gases  from  stored  powder  are  quite  noticeable  at  times  in  the 
vicinage  of  magazines,  and  are  suggestive  of  sulphuric  ether.     The 
formula  depends  upon  the  composition  of  the  explosive. 

(d)  Gases  resulting  from  great  gun  fire  are  very  irritating  to  the 
conjunctiva  and  respiratory  mucosa.     Obviously  the  composition  of  the 
explosive  determines  the  quality  of  the  gases  resulting  from  detonation, 
but  carbon  monoxide  and  nitrogen  gases  are  the  principal  poisonous 
gases.     Carbon  dioxide  also  is  formed. 

(e)  In  the  coal  bunkers  freshly  stored  coal  is  more  apt  to  result  in 
gas  production   than   in   older   coal.     Methane   especially   emanates 
from  freshly  stored  coal,  while  older  coal  gives  off  a  gas  mixture;  in 


AIR   ABOARD   SHIP  39 

which  CO2  is  predominant.  Finely  pulverized  coal  may  absorb  up  to 
three  times  its  volume  of  oxygen,  consequently  great  diminution  of 
oxygen  content  may  occur  in  the  air  of  a  coal  bunker.  The  air  in  coal 
bunkers  may  prove  injurious  to  health: 

i.  Through  generation  of  noxious  gases; 

a.  Through  decrease  of  oxygen  in  contained  air; 

3.  Through  increase  of  COz  tension. 

(/)  Gasolene,  now  used  much  for  propulsion  of  motor  boats, 
driving  auxiliary  machinery,  as  components  of  cleaning  mixtures, 
insecticides,  and  in  gasolene  torches  used  by  painters,  may  vitiate  the 
air  materially  as  well  as  endanger  life  by  explosion  and  fire.  The 
careless  smoker  may  ignite  the  fumes  with  serious  result.  The  "gaso- 
lene jag"  resulting  from  inhalation  of  fumes  of  unburned  gasolene  re- 
sen:  bles  the  stage  of  excitement  of  acute  alcoholism,  muscular  incoordi- 
nation  being  less  marked. 

Inhalation  of  the  fumes  resulting  from  combustion  of  gasolene  gives 
a  graver  picture,  probably  due  chiefly  to  the  carbon  monoxide  con- 
stituent of  the  exhaust  gas. 

(g)  Decomposition  of  food  stuffs;  vegetables,  meat,  eggs,  milk 
products,  etc.,  in  the  galleys,  butcher-shops,  store-rooms,  and  cold 
storage  may  result  in  offensive  gases. 

The  odor  of  oil  decomposing  in  the  moist,  hot  engine  rooms, 
and  bilges  may  become  very  disagreeable,  especially  to  those  who  are 
seasick. 

The  decomposition  occurring  in  water  which  has  been  used  for  bathing 
purposes  and  has  been  secreted  in  a  bucket  for  future  use  and  perhaps 
forgotten,  or  else  poured  into  a  drain  leading  to  a  bilge  or  compartment 
infrequently  pumped  out,  may  be  a  source  of  discomfort  by  reason  of 
its  foul-smelling  odor. 

The  torpedo  drainage  tank -  — a  tank  receiving  the  drainage  from  the 
torpedo  room — is  especially  apt  to  be  a  nuisance  in  this  sense.  Men 
living  most  of  their  time  below  decks  in  the  torpedo  room  frequently 
have  an  unauthorized  supply  of  water  for  washing  purposes  in  buckets 
at  their  stations — despite  the  fact  that  this  is  forbidden — for  it  is  some 
diMance  from  the  torpedo  room  to  the  wash  room.  After  using  this 
\v;iu-r  it  is  emptied  into  the  drains  leading  into  the  torpedo  drainage 
tank.  Here  decomposition  occurs  and  unless  special  attention  is 
paid  to  the  frequent,  regular  pumping  out  and  cleaning  of  the  tank, 
its  content  of  wash  water,  oil,  etc.,  will  become  most  foul.  Needless 


40  NAVAL  HYGIENE 

to  say  the  above-mentioned  disposition  of  bath  water  is  prohibited. 
The  hoarding  of  fresh  water  by  the  sailorman  is  a  relic  of  the  days  when 
he  had  too  small  allowance  of  fresh  water.  In  our  navy  today  his 
allowance  of  fresh  water  is  practically  unlimited.  The  surreptitious 
emptying  of  waste  water  into  unauthorized  places  is  properly  punished 
when  the  offender  is  detected. 

The  air  also  may  be  vitiated  by  the  emanations  from  sweaty  clothing 
and  from  drainage  pipes  leading  from  the  firemen's  wash  room. 

(h)  The  odors  arising  from  turpentine  and  paint  may,  in  close  com- 
partments, prove  dangerous,  causing  irritation  of  conjunctiva,  nasal 
and  respiratory  mucous  membranes,  suppression  of  urine,  and  all 
symptoms  of  turpentine  poisoning.  A  portable  blower  should  be  used 
to  supply  fresh  air  to  such  compartments,  all  openings  of  which  should 
be  wide  open  to  facilitate  ventilation.  Certain  paints  possess  the 
property  of  absorbing  oxygen  from  the  air  and  in  a  close  compartment 
the  percentage  of  oxygen  in  the  air  may  be  far  below  that  necessary 
to  support  life.  Compartments  which-have  remained  closed  for  some 
time,  as  well  as  double  bottoms,  should  not  be  entered  without  pre- 
viously having  been  tested  by  lowering  a  lighted  candle  into  them. 
If  the  candle  flame  goes  out  the  compartment  should  not  be  entered 
until  it  has  been  ventilated  by  opening  thoroughly  and  using  a  port- 
able electric  fan  connected  with  a  duct  which  communicates  with  the 
external  air. 

I  have  treated  a  man  who  was  overcome  by  the  vitiated  air  of  a 
closed  compartment.  He  entered  alone,  going  down  a  ladder.  In  a 
few  seconds  he  called  for  help,  and  a  comrade  barely  succeeded  in 
rescuing  him.  Both  men  suffered  immediate  profound  muscular 
weakness. 

(i)  Even  with  the  most  scrupulous  care  some  odor  will  arise  from 
water  closets  and  fouled  scuppers.  These  are  flushed  with  sea  water, 
but  under  common  temperature  and  humidity  conditions  and  con- 
sidering how  careless  some  persons  are  in  the  use  of  the  water  closet, 
it  is  not  remarkable  that  odor  will  be  present.  Fortunately  there  is 
little  danger  from  odor  arising  from  decomposing  dejecta,  despite  the 
trauma  to  our  aesthetic  sense.  The  danger  here  is  rather  from  direct 
contact  with  door  knobs,  flushing  handles,  hand  grips,  railings  and 
other  objects  which  may  be  contaminated  by  means  of  hands  soiled 
with  urine  or  feces  of  possible  carriers  of  infectious  diseases. 

(j)  Gases  emanating  from  storage  batteries   during  process   of 


AIR   ABOARD    SHIP  41 

charging  may  vitiate  the  air  seriously  within  confined  spaces.  Beck 
(Ueber  die  Bestimmung  und  den  Gehalt  an  Schwefelsaiire  in  den 
Luft  von  Akkumuelatorenbattereien.  Arb.  a.d.  Kaiserl.  Gesundheit- 
sanit,  1909,  S.  77)  has  found  so  much  as  1.51  milligrams  of  sulphuric 
acid  in  100  liters  of  air  in  storage  battery  spaces.  Carbonic  acid  gas, 
hydrogen,  and  water  vapor  also  are  produced.  It  should  be  remem- 
bered that  when  air  is  polluted  by  hydrogen  to  10  per  cent,  or  more  by 
volume,  an  explosive  mixture  is  developed  which  upon  ignition  may 
result  disastrously. 

(k)  Intestinal. — Flatus  may  at  times  form  a  more  considerable 
pollution  of  air  aboard  ship  than  may  be  supposed  by  persons  unfamiliar 
with  living  conditions  aboard  ship.  This  pollution  is  more  noticeable 
after  certain  rations  have  been  eaten  by  the  crew,  e.g.,  beans,  etc. 


ma 


2.    P ARTICULATE    BODIES 

Particulate  bodies  found  in  air  aboard  ship  just  as  in  air  on  shore 
may  be: 

A.  Inorganic; 

B.  Organic. 

A.  The  principal  inorganic  particulate  bodies  in  the  ship's  air  are: 

(a)  Coal  dust; 

(b)  Ashes  and  cinders; 

(c)  Street  dust; 

(d)  Dust  from  chipping  paint; 

(e)  Dust  from  combustion  of  explosives; 
(/)  Sawdust,  etc. 

(a)  Coal  dust,  from  the  constant  handling  of  coal,  coaling  ship, 
cocking,    etc. 

(b)  Ashes   and  cinders   from   the  combustion  of  coal.     Ash  is  a 
m  nor  factor  as  it  usually  is  expelled  by  a  steam  ash  ejector  below  the 
water-line  and  is  satisfactorily  disposed  of.     Cinders  are  a  very  different 
proposition.     Under  certain  conditions  of  draught  the  coal  is  incom- 
pletely burned  and  large  amounts  of  cinders  are  deposited  on  the  decks, 
especially  when  steaming.      Unless  swept  up  frequently  they  cover  the 
<Kck  very  >ot>n. 

Street  dust  conies  from  the  feet  of  many  visitors  as  well  as  from 
the  crew. 


42  NAVAL  HYGIENE 

(d)  Dust  from  Chipping  Paint  and  Scaling. — This   may   be  quite, 
noxious.     Cases  of  lead  poisoning  are  seen  from  time  to  time  in  men 
who  are  scraping  old  paint  or  applying  new. 

(e)  Dust  from  Powder  Explosions. — When  great  guns  are  fired  the 
atmosphere  is  filled  with  gases  and  ash  resulting  from  explosion  of 
several  hundreds  of  pounds  of  smokeless  powder.     This  air  (surround- 
ing the  ship)  gains  access  to  the  living  spaces,  and  with  the  gases  above 
mentioned  causes  marked  respiratory  and  conjunctival  irritation. 

(/)  P articulate  matter  resulting  from  activities  of  crew,  e.g.,  sawdust, 
filings. 

B.  The  principal  organic  participate  bodies  are: 

(a)  Bacteria  from  nasal,  oral,  and  respiratory  mucous  tracts,  and 
from  suppurations  and  diseases  in  crew; 

(b)  Lint  from  clothing; 

(c)  Particles  of  food; 

(d)  Epithelial  debris  and  hair  from  persons  on  board ; 

(e)  Small  particles  of  feces; 
(/)  Insects. 

Man  is  the  chief  cause  and  source  of  transmission  of  man's  infectious 
diseases. 

(a)  Bacteria. — Despite  the  tendency  of  hygienists  to  minimize  air- 
borne infections  we  must  remember  that  on  board  ship: 

1.  There  is  over-crowding,  rendering  contact  easy; 

2.  That  the  air  is  humid,  tending  to  keep  alive  pathogenic  organisms 

3.  That  the  air  is  warm,  favoring  life  of  germs; 

4.  That  the  air  expired,  coughed  and  sneezed  may  contain  virulent 
organisms  capable  of  living  for  some  time  under  the  existing  conditions 
of  temperature  and  relative  humidity. 

Bacteria  from  man  are  being  thrown  off  by  droplet  method,  and  owing  to 
close  herding  of  members  of  the  crew  into  small  compartments  the  chances  of  (air- 
borne) droplet  infection  appear  very  great.  In  this  connection  it  must  be  re- 
membered that  a  person  artificially  infected  with  Bacillus  prodigiosus  coughing  in 
air  in  a  closed  room  has  sprayed  out  droplets  containing  living  bacilli  which  were 
plated  six  hours  after  the  person  who  "coughed  up"  the  bacilli  had  left  the  room. 

Neisser  says  Bacillus  typhosus,  pestis,  vibrio  cholera,  Pneumococcus,  Streptococ- 
cus pyogenes  are  not  spread  by  dust,  but  Staphylococcus  pyogenes  and  Bacillus 
Pyocyaneus,  anthrax  spores,  Meningococci  and  tuberculosis  are  spread  by  dust 
(Prausnitz). 

(b)  Much  lint,  cotton  and  woolen,  is  apt  to  contaminate  the  air  at 
times,  especially  at  night  or  morning,  or  when  a  large  liberty  party 


AIR   ABOARD    SHIP  43 

is  preparing  to  go  ashore  and  when  many  men  are  dressing  or  undressing. 
Living  pathogenic  bacteria  may  be  present  on  the  lint  as  well  as  upon: 

(c)  Particles  of  food  which  gain  access  to  the  air.     It  must  be  remem- 
bered that  the  men  eat,  sleep,  and  live  in  the  same  compartments. 

(d)  and   (e)  Epithelial  debris,   hair  and  comminuted  dried  fecal 
matter  are  also  found  in  dust  collected  aboard  ship.     The  possible 
danger  of  transmission  of  infection  is  seen  here. 

(/)  Insects — mosquitoes,  moths,  flies,  gnats,  beetles — are  taken 
in  :hrough  ventilating  intakes.  They  may  play  an  important  role  in 
disseminating  some  of  the  transmissible  diseases. 

AIR  ANALYSIS 

Air  analysis  consists  of:  (i)  physical  examination,  (2)  chemical 
examination,  and  (3)  bacteriological  examination. 

1.  Physical  Examination. — Physical  examination  consists  in:   (a) 
determining  the  temperature;  (b)  determining  relative  humidity;   (c) 
determining  atmospheric  pressure  with  the  barometer. 

2.  The  Chemical  Examination. — The  chemical  examination  consists 
of  a  series  of  laboratory  procedures  which  are  impracticable  on  board 
a  man-of-war,  because  the  necessary  apparatus  is  not  available,  and  if 
it  were  the  motion  on  board  ship  would  result  in  breakage  and  inac- 
curacies which  would  vitiate  results.     Also  because  services  of  a  skilled 
chemist  cannot  be  had.     In  air  and  gas  analysis  accuracy  of  result 
depends  upon  extreme  care  and  skill  in  the  performance  of  the  labora- 
tory procedures.     Carbon  dioxide  is  the  gas  commonly  estimated. 

Carbon  Dioxide. — CC>2  in  itself  seldom  attains  concentration  enough 
in  air  to  be  really  a  serious  factor  for  consideration.  It  is  estimated 
only  as  an  index  of  other  pollution. 

Occasionally  a  question  will  arise  as  to  the  COa  content  in  a  given 
space. 

The  rough  method  of  Wolpert  modified  by  Bohm  is  readily  available,  requires 
no  elaborate  apparatus,  and  may  be  used  to  advantage.  Take  about  20  c.c.  of 
lime  water  in  each  of  two  test-tubes  of  equal  size  and  thickness. 

Ascertain  how  many  fillings  of  the  rubber  bulb  with  fresh  air  outside  will  be 
needed  to  render  the  limewater  just  turbid  enough  to  obscure  a  pencil  mark  on 
white  paper  placed  under  the  tube  and  viewed  from  above. 

Then  similarly  test  the  suspected  air.  If  we  assume  that  the  outside  air  nor- 
mally contains  0.03  per  cent.  CO2  and  it  takes  15  fillings  of  the  bulb  while  only  5 
fillings  of  the  suspected  air  produce  the  same  turbidity,  we  may  consider  that 


44 


NAVAL  HYGIENE 


3)  suspected  air  has  three  times  the  concentration  of  CO2  that  the  outside 
air  has.  Outside  air  is  most  probably  0.03  per  cent.;  then  3  X  0.03  =  0.09  per 
cent,  in  suspected  air.  This  test  is  accurate  enough  for  practical  work. 

Recently  Higgins  and  Marriott  have  devised  a  colorimetric  method  of  deter- 
mining the  CO2  percentage  in  the  air.  It  depends  upon  the  reaction  of  a  solution  of 
sodium  bicarbonate  through  which  the  air  containing  CC>2  has  been  passed  until 
saturation  has  been  attained. 

This  reaction  will  vary  with  the  CO2  tension  in  the  air  which  has  saturated  the 
sodium  bicarbonate  solution.     Low  pressures  of  COa  will  change  the  reaction  to- 
ward the  alkaline  side,  while  high  pres- 
sures increase  the  acidity. 

The  addition  of  phenolsulphoneph- 
thalein  to  the  sodium  bicarbonate  solu- 
tion as  an  indicator  gives  a  colorimetric 
gauge  of  the  reaction. 

The  comparison  of  the  color  of  the 
solution  under  standard  conditions  with 
that  of  previously  prepared  standard 
solutions  of  varying  reaction  and  of 
known  strengths  enables  a  colorimetric 
reading  of  the  actual  percentage  of  CO2 
in  the  air  tested. 

This  reading  is  direct  and  requires 
no  corrections  for  temperature  unless  it 
is  below  2o°C.  or  above  25°C. 

Similarly  no  correction  for  pressure  is 
required  between  730  and  800  milli- 
meters, i.e.,  no  correction  for  the  sea 
level,  760  millimeters. 

The  method  is  unique,  quick  and 
convenient.  It  is  open  to  the  objections 
that: 

(a)  The  colored  standard  solutions 
are  unstable  and  become  unreliable  after 
a  few  months; 

(b)  The  method  depends  upon  color  perception  and  color  comparisons; 

(c)  The  tests  are  of  such  delicacy  that  the  readings  may  be  badly  vitiated  by  the 
slightest  impurity  in  the  chemicals  used  or  by  expired  air  of  the  operator. 

Carbon  Monoxide. — Carbon  monoxide  is  the  only  other  gaseous 
impurity  of  air  worth  our  consideration  at  this  time.  The  most 
reliable  test  for  it  is  the  spectroscope.  Usually  it  is  not  available. 
Birds  and  mice  or  other  warm-blooded  animals  have  been  used  in  con- 
fined spaces,  as  they  are  affected  by  CO  much  sooner  than  man. 

Paper  saturated  with  a  solution  of  palladium  salts  will  blacken  in 


FIG.  8. — The  apparatus  necessary  for 
rough  estimation  of  carbon  dioxide  con- 
tent in  the  air  after  the  method  of  Wol- 
pert  as  modified  by  Bohm. 


AIR   ABOARD    SHIP  45 

presence  of  CO.  The  quantitative  estimation  of  this  gas  is  a  labora- 
tory problem  seldom  soluble  with  available  apparatus  on  board  ship. 

3.  Bacteriological  Examination.— Bacteriological  examination  of 
air  may  1>e:  (a)  qualitative;  (b)  quantitative. 

(a)  For  the  qutilitdtiir  estimation  of  microorganisms  in  air  the 
IVtri  method  is  best.  By  this  method  a  plate  of  lactose  litmus  agar 
is  exposed  to  the  air  for  five  minutes.  The  area  of  the  plate  is  100 
square  centimeters  and  the  five-minute  exposure  is  supposed  to  give  the 
number  of  organisms  present  in  10  liters  of  air.  Isolation  of  the  colonies 
and  culture  gives  the  varieties  present.  Stitt  states  that  an  exposure 
of  ten  minutes  instead  of  five  will  give  results  which  make  this  method 
a  satisfactory  quantitative  procedure.  He  states:  "The  simplicity 
and  ease  of  access  to  the  colonies  developing  on  it  (the  Petri  plate)  make 

r 


FIG.  9. — Sedgwick-Tucker  aerobiscope.     (Mac  Neal.) 

it  preferable  when  the  air  of  operating  rooms  or  hospital  wards  is  to  be 
examined." 

(b)  The  quantitative  method  devised  by  Sedgwick  in  which  the 
Sedgwick-Tucker  aerobioscope  is  used  should  be  mentioned.  The 
aerobioscope  is  a  glass  instrument  which  has  a  support  in  one  end  and 
upon  this  granulated  sugar  is  poured  in  a  thin  layer,  the  aerobioscope 
having  been  previously  sterilized.  The  instrument  and  sugar  are 
then  resterilized  in  dry  heat  at  a  temperature  not  exceeding  i2o°C., 
to  avoid  melting  the  sugar.  A  given  quantity  of  air  is  then  drawn 
through  the  sterilized  sugar.  The  latter  is  shaken  down  into  the  large 
chamber  of  the  instrument  and  10  or  15  c.c.  of  melted  gelatin  are 
poured  in  upon  it.  The  tube  is  now  rolled,  as  in  making  roll  cultures 
and  incubated  at  room  temperature.  After  this  the  colonies  may  be 
counted  and  the  number  per  liter  may  be  estimated. 

Rettger's  method  is  an  excellent  one:  A  given  quantity  of  air  is 
bubbled  through  salt  solution.  The  bacteria  in  the  air  are  caught  in 
the  solution  and  may  be  plated,  incubated,  and  counted  by  the  methods 
commonly  employed  in  bacteriological  work. 


CHAPTER  VII 
VENTILATION 

MAN'S  REQUIREMENTS 

It  is  generally  agreed  that  where  it  is  possible  the  adult  should  have 
an  air  supply  of  3000  cubic  feet  per  hour,  never  less  than  2000,  in  order 
to  dilute  his  own  gaseous  exhalations  to  a  point  where  the  CO2  will 
not  exceed  6  or  7  parts  per  10,000.  (It  must  be  borne  in  mind  that  the 
carbon  dioxide  component  in  any  atmosphere  ordinarily  breathed  by 
human  beings  may  be  regarded  as  negligible  from  the  sanitary  stand- 
point, except  in  so  far  as  its  increase  within  closed  spaces,  such  as  rooms, 
etc.,  may  be  interpreted  as  an  index  of  the  corresponding  increase  in 
temperature,  humidity,  and  volatile  products  from  alimentary  and 
respiratory  tracts,  as  well  as  the  skins  and  clothing  of  occupants  of 
such  spaces.) 

Additional  allowance  should  be  made  for  spaces  where  excessive 
CO2  or  other  gaseous  pollution  may  occur. 

Pettenkofer  demonstrated  that  2500  cubic  feet  of  air  may  be  passed 
through  a  space  of  424  cubic  feet  in  an  hour  without  producing  per- 
ceptible drafts.  So  that  in  a  room  8  by  8  by  6.5  feet  the  air  could  be 
renewed  six  times  per  hour  without  discomfort  from  drafts.  When  the 
air  in  a  given  space  is  changed  of tener  than  three  to  four  times  per  hour, 
i.e.,  if  the  cubic  capacity  of  a  room  be  completely  changed  more  than 
about  four  times  per  hour  drafts  are  apt  to  be  felt  somewhere  in  the 
space.  This  then  would  mean  that  the  minimum  air  space  per  man 
would  be  3000  -r-  4  =  750  cubic  feet  per  man,  per  hour. 

In  barracks  and  habitations  on  shore  considerable  ventilation  occurs 
imperceptibly  through  the  chinks  and  cracks  in  the  walls  at  and  around 
the  natural  openings,  such  as  doors  and  windows.  In  addition  to  this 
it  must  be  remembered  that  a  number  of  building  materials  possess 
considerable  permeability  for  air,  and  far  more  transpiration  occurs 
through  unpainted  brick  or  wooden  walls  than  generally  is  realized. 
It  is  stated  that  an  average  unglazed  brick  will  absorb  about  one  pint  of 

46 


VENTILATION 


47 


water,  which,  in  view  of  the  composition  of  brick,  is  tantamount  to 
saying  that  a  brick  contains  a  corresponding  amount  of  air. 

The  permeability  of  unglazed  brick  well  may  be  illustrated  in  the  following 
manner: 

With  sealing  wax  the  mouths  of  two  glass  funnels  are  fastened  on  to  the  un- 
covered surface  of  a  brick,  and  all  the  area  of  the  brick  except  that  covered  by  the 
mouths  of  the  two  funnels  is  completely  coated  with  sealing  wax,  thus  preventing 
absorption  or  escape  of  air. 

One  funnel  is  connected  to  a  bottle,  the  rubber  stopper  of  which  contains  two 
perforations,  one  for  a  glass  terminal  tube  leading  from  the  funnel,  and  opening 
into  the  air  chamber  in  the  bottle,  above  the  water  which  partially  fills  it.  Extend- 


10. — Apparatus  to   demonstrate  permeability  of  brick. 


ing  through  the  second  opening  in  the  stopper,  and  below  the  surface  of  the  water, 
is  a  thistle  tube  through  which  water  may  be  poured,  thus  increasing  the  volume  of 
wat3r  in  the  bottle,  and  correspondingly  decreasing  (for  all  practical  purposes) 
the  contained  volume  of  air.  This  air  is  forced  out  through  the  tube,  enters  and 
passes  through  the  brick,  and  if  a  rubber  tube  be  connected  with  the  funnel  attached 
to  tie  opposite  side  of  the  brick,  and  the  distal  end  of  this  tube  submerged  in  a  basin 
of  v.-ater,  the  escape  of  air  from  the  bottle  through  the  brick  will  be  made  evident 
by  l;he  bubbling  of  water  in  the  basin. 

Glazed  brick,  painted  surfaces,  or  papered  interior  walls,  limit  this 
natural  passage  of  air  through  the  walls. 

Soldiers  in  barracks  should  have  at  least  a  6-foot  by  lo-foot  floor 
area  with  a  1 2-foot  ceiling.  The  above  are  minimum  figures.  The  more 
space  the  better  within  reasonable  limits. 


48  NAVAL  HYGIENE 

Life  aboard  ship  is  essentially  a  life  of  over-crowding.  Space  is 
given  to  munitions,  stores,  coal,  machinery,  etc.,  and  the  available  air 
space  is  reduced  far  below  that  ordinarily  regarded  as  necessary  to  man's 
welfare  on  shore.  It  is  questionable  whether  the  most  crowded  tene- 
ment "rookeries"  will  show  smaller  per  capita  air  space. 

A  classical  case  of  disaster  due  to  over-crowding  at  sea  is  that  of  the  "London- 
derry, "  which  was  caught  in  a  storm  while  making  passage  between  Sligo  and  Liver- 
pool in  1848.  Owing  to  the  severity  of  weather  it  became  necessary  for  their  safety 
to  confine  two  hundred  steerage  passengers  in  a  poorly  ventilated  compartment 
which  afforded  less  than  7  cubic  feet  of  air  space  per  person.  More  than  70  out 
of  the  200  were  found  dead  when  the  compartment  was  opened  on  the  following 
morning. 

Of  course  such  conditions  are  unheard  of  today,  but  this  instance  is  cited  as  the 
analogue  of  the  Black  Hole  of  Calcutta  on  shore,  in  which  146  prisoners  were  con- 
fined over  night  in  a  military  prison,  the  air  space  of  which  was  less  than  5900  cubic 
feet.  There  were  two  small  windows,  but  these  were  on  one  side  of  the  room.  On 
the  following  morning  123  of  the  prisoners  were  found  dead. 

No  doubt  the  high  temperature  and  humidity  in  the  latitude  of  Calcutta  added 
much  to  what  otherwise  would  have  been  intolerable  conditions. 

Afloat. — Afloat  it  is  seldom  possible  to  attain  the  desirable  cubic 
space  per  man,  for  a  merchant  ship  is  a  carrier  of  passengers  and 
freight,  and  every  cubic  foot  of  space  must  be  utilized  to  the  greatest 
advantage  in  order  to  yield  the  maximum  return  to  investors.  On  men- 
of-war,  machinery,  munitions,  fuel,  stores,  and  other  equipment  neces- 
sary for  the  ship's  paramount  function  occupy  space  which  reduces 
greatly  the  cubic  volume  which  could  be  allotted  to  the  personnel. 

The  crew  in  its  sleeping  places  on  board  ships  of  the  following 
navies  has  cubic  air  space  as  given  below,  by  the  authorities  cited: 

Cubic  meters  Cubic  feet 

German  Navy  (Plumert)  1.5-8  =     47~25° 

British  Navy  (Beadnell)  4.24-8.2  =    132-250(249.6) 

Italian  Navy  (Belli)  4.55-10  =   141-312 

U.  S.  Navy  (Gatewood)  5.6  =165 

The  sick  bay  on  the  U.  S.  S.  Pennsylvania  has  a  cubic  capacity  of 
320  cubic  feet  per  capita.  The  air  in  this  space  is  changed  every 
eight  minutes  by  combined  supply  and  exhaust  systems.  In  the 
German  Navy  468  cubic  feet  per  capita  is  given  as  the  allowance  of 
air  in  sick  bay,  but  the  rate  of  change  is  not  given. 

In  officers'  cabins  the  ships  of  the  United  States  and  Germany  give 


VENTILATION 


49 


about  25  cubic  meters  =  780  cubic  feet.  Those  of  the  Italian  Navy 
have  12  cubic  meters  =  375  cuni("  t(A'1- 

In  igio  the  British  Admiralty  appointed  a  commission  of  prominent 
civilian  and  naval  authorities  to  study  prevalence,  prevention  and 
results  of  tuberculosis  in  the  British  Navy.  This  commission  estab- 
lished a  fixed  minimum  standard  of  200  cubic  feet  of  air  space  per 
individual. 

On  the  recently  constructed  Pennsylvania  class  (United  States 
Navy)  the  officers'  staterooms  are  given  a  cubic  capacity  of  800  cubic 
fee:,  and  the  crew  150  cubic  feet  per  hammock. 


It  is  used  for  measuring  the  velocity  of  currents  of 
air. 

ien  it  is  considered  that  at  least  one-third  of  the  crew  is  always 
on  watch,  and  that  in  port  large  liberty  parties  are  on  shore  it  will  be 
realized  that  the  air  space  just  mentioned  is  more  liberal  than  it  appears. 
Ju>t  here  attention  is  called  to  the  open  character  of  sleeping  spaces  for 
the  crew  on  board  ship.  Many  ships,  especially  men-of-war,  have  their 
berthing  spaces  unbroken  by  bulkheads,  as  for  instance  on  the  gun 
dei  k  where  the  hammocks  swing  as  if  in  a  large  hall  rather  than  in 
several  small  rooms.  This  absence  of  bulkheads  facilitates  both  natural 
and  artificial  air  change,  and  in  such  large  compartments  the  cubic 
air  spaces  per  capita  may  be  smaller  than  would  be  comfortable  in  small 
rooms  whose  aggregate  volume  equals  that  of  the  large  space.  On  the 
IVnnsylvania  \ve  ol^erve  that  the  air  space  in  the  small  officers'  state- 
re  oms  is  800  cubic  feet,  whereas  on  the  more  open  decks  150  cubic 


50  NAVAL  HYGIENE 

feet  per  capita  suffices.  The  air  can  be  changed  ten  to  twelve  times 
per  hour  in  large  spaces,  but  in  the  small  spaces  it  may  be  changed 
not  exceeding  four  to  six  times  without  discomfort. 

The  medical  officer  should  make  regular  observations  with  wet  and 
dry  bulb  thermometers  in  all  working  and  living  spaces,  and  if  the  air 
supply  seems  unsatisfactory,  specimens  of  air  should  be  taken  for 
analysis. 

To  supply  the  necessary  volume  of  fresh  air  the  minimum  cubic 
space  per  capita  allotted  for  small  rooms  ashore  is  750  cubic  feet,  but 
in  large  buildings,  such  as  halls,  theaters,  and  churches,  the  air  may 
be  changed  oftener  without  discomfort  and  the  per  capita  air  space  is 
placed  at  300  cubic  feet. 

Finally,  we  must  deliver  3000  cubic  feet  of  air  per  man  per  hour  to 
supply  his  requirements,  ashore  or  afloat.  This  is  done  by  ventilation. 

Ventilation. — Ventilation  is  the  process  of  withdrawing  air  laden 
with  gases,  particulate  matter,  and  bacteria  from  an  enclosed  space  and 
replacing  it  with  pure  air  of  proper  temperature,  humidity,  and  motion. 
In  order  to  prove  effective  this  exchange  should  be  continuous.  In 
the  consideration  of  ventilation  it  should  be  remembered  that  this 
exchange  of  fresh  air  for  foul  should  occur  at  the  breathing  zone. 
Whether  on  board  ship  or  on  shore  the  necessary  ventilation  of  air 
spaces  is  accomplished  by  means  of  (i)  natural  ventilation  and  (2) 
artificial  ventilation.  By  natural  ventilation  is  meant  the  air  exchange 
which  occurs  through  the  usual  openings  of  an  inclosed  space  as  result 
of  natural  causes.  Artificial  ventilation  effects  exchange  of  the  air  by 
mechanical  means. 

NATURAL  VENTILATION 

Natural  ventilation  is  ventilation  resulting  from  operation  of  the 
following  natural  causes: 

(a)  Difference  in  temperature  and  consequent  difference  in  pressure; 

(b)  Perflation; 

(c)  Aspiration; 

(d)  Diffusion;  ! 

(e)  Humidity; 

(/")  Motion  of  man,  animals,  and  objects  moved  incident  to  man's 
activities. 

(a)  Difference  in  Temperature. — When  a  given  volume  of  air 
is  heated,  it  expands,  and  becoming  lighter,  rises.  These  physical 


VENTILATION  51 

characters  are  the  causes  of  air  interchange  which  is  due  to  pressure 
differences  caused  by  temperature  differences.  The  air  from  a  point 
of  high  pressure  flows  toward  the  area  of  low  pressure;  hence  as  the 
heated  air  rises  currents  of  cold  air  rush  in  to  take  its  place.  Morin 
studied  this  problem  and  found  that  400  cubic  meters  of  air  escaped 
through  the  chimney  of  his  study  each  hour  when  there  was  only  2i°F. 
difference  between  the  air  in  his  study  and  the  air  outside.  This 
pressure  difference  dependent  upon  temperature  difference  in  the  air 
on  a  grand  scale  is  responsible  for  all  of  our  winds  in  nature,  therefore 
of  course  (b)  perflation  and  (c)  aspiration  fundamentally  are  dependent 
upon  thermal  difference. 

(b)  Perflation  acts  when  the  wind  blows  in  such  a  way  that  the 
resultant  of  its  force  sets  up  air  currents  and  blows  through  an  enclosed 
space.     Drafts  are  caused  in  this  way. 

(c)  Aspiration. — A  current  of  air  passing  by  an  opening  in  an 
enclosed  space  tends  to  extract  air  from  the  space,  although  the  causa- 
tive air  current  does  not  actually  enter.     This  principle  is  often  found 
of  value  in  ventilating  enclosed  spaces. 

(d)  Diffusion. — Air  being  a  mixture  of  gases  follows  the  physical 
laws  applicable  to  gases. 

(e)  Humidity. — Moist  air  being  lighter  than  an  equal  volume  of 
dry  air  under  the  same  conditions  of  temperature  and  pressure,  tends 
to  establish   upward   currents  when   coming  in   contact  with  dryer 
(heavier)  air. 

(f)  Motion  of  Man,  Animals,  and  Objects  Moved  Incident  to 
Man's  Activities. — Natural  ventilation  also  is  caused  to  some  extent 
by  the  motion  of  air  resulting  from  the  movements  of  animals,  man, 
an  1  objects  connected  with  his  activities,  for  instance:  railway  trains, 
skumships,  automobiles,  machinery,  etc. 

For  natural  ventilation  hygienists  allot  to  each  occupant  of  an 
enclosed  space  at  least  24  square  inches  of  window  space. 
I'l  i^  allowance  is  too  small. 

On  board  ship  natural  ventilation  differs  materially  from  that  ashore. 
The  employment  of  steel  in  constructing  the  hulls  of  ships  renders 
impossible  any  natural  ventilation  through  the  ship's  side  other  than 
that  through  the  natural  openings.  If  a  ship's  hull  is  water-tight,  it 
must  also  be  air-tight.  Transpiration  through  the  impermeable  steel 
does  not  occur. 

Below  the  water-line,  for  purposes  of  safety,  merchant  ships  as  well 


52  NAVAL  HYGIENE 

as  naval  vessels  usually  are  divided  into  water-tight  compartments, 
which  commonly  are  closed  except  for  inspections,  drills,  cargo  storing, 
cleaning,  and  repairs  incident  to  the  upkeep.  Often  such  compartments 
have  only  a  single  opening  into  them,  namely  the  hatch  through  which 
merchandise  or  stores  may  be  loaded  and  unloaded.  Manifestly  such  a 
compartment  resembles  somewhat  a  bottle  which  has  a  single  opening 
at  the  neck,  and  here  natural  ventilation  cannot  be  depended  upon 
to  supply  the  adequate  amount  of  fresh  air  for  the  proper  aeration 
of  such  spaces.  Double  bottoms,  wing  passages,  and  other  compart- 
ments which  usually  are  kept  closed  should  be  entered  with  caution 
because  of  possibility  of  air  pollution  or  absorption  of  the  oxygen 
content  by  paint  (or  other  oxidizable  matters)  below  the  percentage 
required  for  maintenance  of  life. 

Above  the  water-line  the  subdivision  of  deck  spaces  by  water-tight 
bulkheads  does  not  hold  to  the  same  degree,  especially  on  freight  ships 
and  naval  vessels.  Consequently  there  is  less  interruption  of  the 
sweep  of  air  currents  which  gain  entrance  through  natural  openings. 
On  passenger  ships,  however,  the  cubicle  or  cellular  system  of  subdi- 
vision of  spaces  between  decks  is  a  necessity  if  passengers  are  to  have 
staterooms.  In  such  constructions  there  is  essentially  great  inter- 
ference with  natural  ventilation. 

Local  temperature  differences  operate  here  to  a  very  remarkable 
degree.  The  large  amount  of  heat  generated  in  making  steam,  con- 
ducting steam  through  steam  pipes  to  auxiliary  machinery,  distillation 
of  water,  cooking,  etc.,  causes  the  air  within  those  spaces  to  be  heated 
rapidly,  thus  tending  to  force  the  lighter  hot  air  upward,  establishing 
air  currents  which  bring  in  air  from  the  outside  of  the  ship.  If,  however, 
the  temperature  in  the  external  atmosphere  is  above  90°  some  of 
these  currents  may  be  reversed,  the  warmer  outside  air  tending  to 
enter  the  usual  channels  of  exit.  The  sunny  side  of  a  ship  is  warmer, 
and  the  air  on  that  side  tends  to  rise,  thus  establishing  currents  of 
cooler  air  toward  that  side.  The  same  may  be  said  of  heated  bulkheads 
or  portions  of  spaces  through  which  steam  pipes  run.  The  windy  side 
of  a  ship  will  be  subjected  to  more  rapid  evaporation  and  cooling,  conse- 
quently air  currents  may  go  from  the  cool  side  to  the  warmer. 

Natural  ventilation  of  a  ship  occurs  through  permanent  openings 
in  her  decks  or  hull,  such  as: 

1.  Hatches,  or  openings  in  the  deck  for  access  to  spaces  below; 

2.  Ventilating  cowls  or  shafts; 


VENTILATION 


53 


3.  Air-ports  or  windows  in  the  ship's  sides; 
4    Smoke  pipes  and  smoke-pipe  casings; 

5.  Elevator  shafts; 

6.  Chutes; 

7.  Voice  tubes; 

8.  Cargo  ports  on  a  merchantman; 

9.  Ammunition  hoists; 

10.  Gun-ports  on  a  man-of-war. 

1.  Hatches  are  openings  in  a  ship's  deck  made  for  access  to  spaces 
below,  and  may  be  closed  and  made  water-tight. 

2.  Ventilating  Cowls  and  Intakes. — Ventilating  cowls  are  heavy 
metal   tubes  of  large  diameter,  extending   through  and  well  above 

the    decks,    terminating    in    a   flaring 
mouth  which  revolves  and  may  be  di- 
/A  f]AA  rected  (" trimmed")  toward  the  wind. 

•  ^~^  *\  The  mouth  of  a  cowl  should  be  covered 

J      \         \  by  a  wire  grating  to  prevent  persons 

/  \  falling   down,   or   large   objects    being 

•  thrown  through  the  cowls.     The  lower 

-     ;  end  of  a  cowl  terminates  in  a  system 

of  tributary  air  ducts  going  to  different 
compartments. 

The  so-called  mushroom  cowl  is 
covered  by  a  strong  metal  cover  which 
gives  the  cowl  its  name. 

The  most  efficient  cowl  is  so  con- 
structed as  to  deflect  water  centrifugally  and  drain  it  away  when  the 
vessel  "ships  a  sea,"  yet  it  enables  air  to  enter  (Courbet  type). 

Frequently  a  bitt  is  utilized  as  a  small  ventilating  cowl.  It  has  a 
feriestration  opening  into  its  hollow  interior,  and  communicating  with 
a  -pace  below  the  deck  from  which  the  bitt  projects. 

A  common  application  of  tin-  principles  of  perflation  and  aspiration 
is  seen  in  the  trimming  of  ventilating  cowls. 

One  cowl  is  trimmed  (" trained")  so  that  the  plane  of  its  mouth  is 
perpendicular  to  the  course  of  the  wind.  This  position  enables  the 
entrance  of  a  maximum  quantity  of  the  moving  air,  which  is  directed 
do\vir  ird  and  through  the  compartment — perflation. 

On  the  opposite  side  from  the  wind,  the  lee  side,  the  mouth  of  the 
cowl  is  directed  away  from  the  wind,  thus  causing  the  passing  wind  to 


/       \ 

I'M..  12. — A  mushroom  cowl. 
Th.-  arrows  indicate  the  course  of 
air  rnU'rinK  under  the  hood  of  the 
cov/1  and  going  down  to  the  com- 
part im-nt  below. 


54 


NAVAL   HYGIENE 


aspirate  from  its  mouth  currents  of  air  which  are  drawn  from  the  com- 
partment below — aspiration.  Here  perflation  and  aspiration  by  their 
combined  action  tend  to  force  in  fresh  and  exhaust  foul  air  from  the 
compartment. 

Ventilating  cowls  have  variously  modified  mouths,  each  being 
supposed  to  possess  some  special  merit.  In  general  it  may  be  said  that 
the  simpler  the  construction  of  intake  (or  mouth)  the  better. 


FIG.  13. — Ventilating  cowls  trimmed  to  facilitate  perflation  of  the  deck  below. 
One  cowl  is  trained  to  receive  the  wind,  the  other,  trained  in  the  opposite  direction, 
serves  as  an  exhaust.  The  arrows  indicate  the  direction  of  air  currents. 

3.  Air-ports  are  openings,  usually  circular,  in  the  steel  side  of  the 
ship,  and  serve  the  same  function  as  windows  in  buildings  on  shore — 
permitting  the  flow  of  air  in  and  out  and  admitting  light.     Air-ports 
are  closed  by  circular  frames  snugly  fitting  upon  rubber  gaskets  making 
water-tight  joints.     The  frames  are  filled  with  a  very  strong  "dead- 
light" or  glass  which  admits  light  even  if  the  port  must  be  closed  to 
prevent  entrance  of  water  from  a  rough  sea. 

4.  Smoke  Pipes  and  Smoke-pipe  Casings. — The  smoke  pipes  from 
the  fire  room  by  reason  of  the  draft  caused  by  the  ascent  of  heated  air 
aid  materially  in  ventilating  the  spaces  from  which  they  may  draw. 


VENTILATION 


55 


On   the  same  principle  the  space  between  the  smoke  pipe  and  its 
casing  is  utilized  as  an  exhaust  for  air  contained  in  its  tributary  spaces. 

5.  Elevator  shafts  serve  as  uptakes  and  permit  rise  and  exit  of 
heated,  humid  air  vitiated  in  spaces  below. 

6.  Chutes  or  Scuttles,  tubular  channels  for  loading  cargo  in  bulk, 
coaling  ship,  etc.,  serve  similar  purpose. 

7.  Voice  tubes  aid  natural  ventilation  in  a  small  way,  yet  it  is 
easily  conceivable   that  such  a 

tube,  by  virtue  of  its  communi- 
cation with  respirable  air,  might 
save  a  life  in  a  compartment 
filled  with  water  or  irrespirable 
gases. 

8.  Cargo  ports  are  for  load- 
ing     cargo.     They     are     large 
windows  opening  into  the  ship's 
side,  and  are  closed  by  means  of 
steel     shutters,     which,      when 
closed,  make  water-tight  joints. 
As    these    ports    open   between 
decks,  their  uses  in  natural  ven- 
tilation are  obvious.     If  it  is  not 
cold  they  may  be  kept  open  in 
good  weather. 

9.  Ammunition     hoists     are 
modified  elevators  for  carrying 
ammunition    from   one   deck  to 
another.     The    shafts     through 
which   these  carriers  pass  serve 


— ff 

-if 

di 


FIG.   14. — A   sketch   showing  how  the 
interval   between  the  smoke  pipe  and  the 


also   the  purposes  of  natural  ven-      smoke-pipe  casing  may  be  used  as  a  ven- 


tilating  uptake.     The  arrows  indicate  the 

•.  •    .«  *          * 

direction  of  the  draft. 

10.  Gun  -ports  are  the  open- 

ings in  the  side  of  a  warship  through  which  the  guns  pass  and  are 
trained.  Gun-ports  are  large  and  afford  good  natural  ventilation  to 
the  spaces  into  which  they  open. 

The  desire  to  utilize  natural  ventilation  to  the  fullest  extent  on 
board  ship  has  led  men,  in  addition  to  natural  openings,  in  the  deck  and 
hull  of  a  ship,  to  employ: 

i.  Scoops; 


NAVAL   HYGIENE 


2.  Windsails; 

3.  Screens. 

These  are  devices  for  deflecting  the  wind  effectually  into  the  ship's 
natural  openings. 

i.  Scoops  usually  are  made  of  galvanized  iron  plates  bent  into  a 
scoop  shape.  At  one  end  of  the  scoop-shaped  plate  is  attached  a 
collar  which  snugly  fits  into  the  air-port,  as  the  circular  window  in 


FIG.  15. — The  scoop  is  projecting  out  of  an  air  port  and  would  deflect 
current  through  the  air  port  into  the  room  within.  Note  the  life  lines  above, 
surround  the  deck  and  prevent  falling  overboard. 


t  an  air 


They 


the  ship's  side  is  called,  and  holds  the  scoop  in  place  after  it  is  thrust 
through  the  air-port.  The  other  end  of  the  scoop  presents  a  graceful 
rounding  of  its  corners.  The  margins  of  the  scoop  are  stiffened  by 
being  rolled  over  so  as  to  form  a  miniature  tubular  channel. 

Scoops  vary  in  size,  the  radius  of  their  curvature  varying  with  that 
of  the  air-port  through  which  the  scoop  is  designed  to  extend. 


VENTILATION 


57 


When  the  scoop  is  in  place,  it  projects  about  2  feet  from  the  ship's 
side,  and  deflects  the  air  striking  it  into  the  air-port  through  which  it 
projects.  Obviously  its  efficiency  depends  upon  the  velocity  of  air 
currents  met  by  it.  The  scoop  is  a  most  useful  aid  to  natural  ventila- 
tion of  spaces  between  decks. 


.  ?ni!v 

FK..    ic>.    -A  windsail  extending  down  through  a  hatch  on  deck. 

Windsails  are  canvas  funnels  or  tubes  having  spreading  wings  on 
t-arh  side  near  the  top,  which  is  closed.  Windsails  may  be  stayed  so 
as  to  catch  the  wind  and  deflect  the  moving  air  down  the  canvas  tube 
into  the  spaces  between  dirks,  thus  facilitating  natural  ventilation. 

Wooden  hoops  placed  at  intervals  serve  to  keep  the  windsails 
patent. 

3.  Screens. — Canvas  screens  lashed  to  stanchions  sometimes  may 


58  NAVAL   HYGIENE 

prove  very  useful  in  deflecting  wind  downward  through  a  hatch. 
Often,  however,  the  hatch  cover  may  be  made  to  serve  the  same  pur- 
pose, provided  the  wind  comes  from  the  right  direction.  The  hatch 
covers  being  hinged  to  the  coaming  are  not  always  available,  as  they 
cannot  be  spread  to  the  wind  coming  from  all  quarters  as  can  screens. 

Conditions  Affecting  Natural  Ventilation. — Natural  ventilation 
of  ships  is  affected  by: 

i.  Velocity  of  the  wind; 


FIG.    17. — A  vessel  in  the  tropics  showing  windsails  set,   awnings  spi 
"scrub  and  wash  clothes"  on  the  clothes  lines. 

2.  Speed  of  the  ship; 

3.  Direction  of  the  wind; 

4.  Course  of  the  ship; 

5.  Differences  peculiar  to  the  locality  through  which  the  ship  may 
be  passing. 

i.  The  natural  ventilation  of  a  ship  "  dead  in  the  water"  is  modified 
by  the  velocity  of  the  wind  blowing  past  it — the  greater  the  velocity 
within  limits  of  safety,  the  greater  will  be  the  effect  of  the  resulting 


VENTILATION  59 

perflf.tion  and  aspiration.     The  effect  is  analogous  to  the  effect  of  wind 
upon  a  building  on  shore. 

2.  Ships  are  "dead  in  the  water"  but  a  small  portion  of  their  time. 
One  of  their  functions  is  to  move  about.     The  speed  with  which  a  ship 
moves  modifies  the  effect  of  the  wind's  velocity  upon  natural  ventilation 
of  her  spaces. 

A  ship  proceeding  at  the  rate  of  15  miles  per  hour  in  the  absence  of  wind  makes 
for  herself  an  air  current  of  about  15  miles  per  hour,  due  to  her  motion.  If  she  is 
steaming  into  a  head  wind  having  the  rate  of  15  miles  per  hour,  for  purposes  of 
natural  ventilation  the  ship  is  encountering  a  wind  whose  rate  is  equal  to  that  of  the 
actual  velocity  of  the  wind  plus  the  rate  of  the  ship's  speed.  If  however  the  ship  is 
going  at  the  same  rate  of  speed,  15  miles  per  hour,  and  a  wind  having  velocity  of  15 
milrs  per  hour  is  blowing  from  astern,  the  effect  upon  natural  ventilation  prac- 
tically would  be  to  neutralize  the  air  currents  in  such  way  that  the  air  about  the 
ship  A'ould  seem  stagnating.  In  the  Red  Sea  at  times  the  temperature  is  so  high, 
and  i  ho  winds  are  of  such  character,  that  in  order  to  give  relief  to  the  oppressed 
crews  in  the  engine  rooms  it  has  been  necessary  to  turn  the  ship  completely  around 
and  to  steam  in  the  opposite  direction  in  order  to  ventilate  thoroughly  the  lower 
spaces. 

3.  The  direction  of  the  wind  may  have  the  effect  of  greatly  augment- 
ing or  completely  neutralizing  the  air  currents  established  as  result  of 
tin-  -hip's  own  motion.     The  wind  coming  abeam  (90°  from  the  way  the 
ship  is  heading)  has  excellent  effect  on  ventilating  the  ship's  spaces 
whi.-h  are  open,  since  the  wind  or  breeze  tends  to  blow  more  directly 
through  the  ship  than  is  the  case  when  the  wind  is  dead  ahead  or  dead 
astern.     The  maneuvering  of  war  vessels  in  which  they  are  moving 
about  on  the  water  as  a  company  of  soldiers  drills  on  shore,  heading 
first  in  one  direction  and  then  another,  is  a  powerful  adjuvant  to  natural 
ventilation.     It  is  believed  that  the  effect  of  the  ship's  maneuvering 
is  greater  upon  her  contained  air  volume  than  generally  is  realized. 

4.  Course  of  the  Ship. — Natural  ventilation  is  modified  by  the 
course  of  the  ship  in  that  her  course  determines  her  relation  to  a  given 
wild,  whether  she  meets  it,  whether  the  wind  is  following,  or  whether 
fro  11  another  quarter. 

5.  Differences  peculiar  to  the  locality  through  which  the  ship  may 
-sing.     In  certain  localities  well-recognized  air  currents  are  preva- 
lent during  certain  periods  of  tin-  year.     For  instance  the  trade  winds, 
and  the  monsoons.     Again  there  are  sections  where  periods  of  great  calm 
arc    experienced.     Every  sailor  dreads  the  Doldrums.     Sails  do  not 
draw,  and  vessels  depending  solely  on  the  wind  are  left  for  days,  mak- 


60  NAVAL   HYGIENE 

ing  little  progress  on  their  course.  Obviously  the  localities  where  trade 
winds  are  prevalent  would  modify  natural  ventilation. 

Along  the  coasts  in  various  parts  of  the  world  a  breeze  from  sea 
blows  toward  the  land  for  about  twelve  hours,  and  then  the  wind  shifts, 
blowing  from  the  shore.  Within  the  sphere  of  influence  of  this  wind, 
for  instance  in  harbors  and  in  coastwise  cruising,  natural  ventilation 
of  ships  is  materially  facilitated  by  these  alternating  winds. 

The  swinging  of  a  ship  at  anchor  in  adapting  herself  to  the  wind 
and  tide  modifies  natural  ventilation  accordingly. 

ARTIFICIAL  VENTILATION 

Artificial  ventilation  consists  in  the  constant  and  mechanical 
exchange  of  air  contained  in  a  given  space  for  an  adequate  supply  of 
fresh,  pure,  atmospheric  air  which  may  or  may  not  be  conditioned 
(heated,  cooled,  or  humidified),  and  which  is  kept  in  gentle  motion, 
especially  in  the  breathing  zone. 

On  Shore. — The  apparatus  used  for  artificial  ventilation  ordinarily 
consists  of  a  large  chamber  containing  a  fan  or  blower,  the  chamber 
having  communication  through  a  duct  with  the  air  external  to  the  build- 
ing, and  the  opposite  side  of  the  chamber  communicating  with  a  system 
of  ducts  which  enter  the  various  spaces  to  be  ventilated.  The  fan  or 
blower  commonly  is  driven  by  an  electric  motor.  Depending  upon  the 
direction  for  which  it  is  designed  to  operate,  the  apparatus  may  draw  air 
from  the  exterior,  passing  it  through  the  chamber  and  expelling  it 
as  fresh  air  through  its  system  of  ducts,  which  may  be  compared  to 
bronchial  tubes.  If  designed  to  operate  in  the  opposite  manner,  the 
fan  will  draw  air  from  the  various  ducts  above  mentioned  and  expel 
it  into  the  atmospheric  air  outside  the  building.  Thus  it  will  be  seen 
that  there  are  three  systems  of  artificial  ventilation  which  may  be  used: 

1.  The  plenum  or  supply  system; 

2.  The  exhaust  system; 

3.  A  combination  of  the  plenum  and  exhaust  systems. 

I.  The  plenum  or  supply  system  is  that  in  which  the  fresh  air  is 
drawn  from  without  and  supplied  by  means  of  a  rotary  fan  or  blower 
to  the  spaces  to  be  ventilated.  For  most  spaces  this  is  the  best  system 
of  artificial  ventilation  if  it  is  not  practicable  to  combine  it  with  the 
exhaust  system.  The  intake  for  atmospheric  air  should  be  situated 
as  high  as  possible  on  the  building  in  order  to  avoid  much  of  the  c  ust 


in  the  lower  air  strata.  The  intake  should  further  be  carefully  placed 
with  reference  to  chimneys  or  other  sources  of  air  pollution  in  order 
to  avoid  distributing  vitiated  air  throughout  the  building.  The 
intake  should  be  carefully  screened  against  insects. 


FIG.  1 8. — Flies  and  insects,  some  living  and  some  dead,  which  had  passed  by  the 
po\\  t-rful  rotary  fan  and  were  distributed  to  the  decks  below.  The  above  picture 
was  taken  at  the  outlet  of  a  supply  louver  and  shows  the  insects  on  deck  in  an  ammu- 
nition passage;  ».  e.,  well  below  the  ship's  water-line. 


The  terminals  of  the  various  distributing  ducts  vary  in  pattern  and 
location. 

Type  of  Terminal  Devices. — Numerous  ingenious  devices  have  been 
employed  as  terminals  for  the  air  ducts,  but  it  is  believed  that  perhaps 


62  NAVAL  HYGIENE 

the  best  is  merely  the  expansion  of  the  duct  in  the  form  of  a  truncated 
cone,  the  base  of  which  constitutes  the  ultimate  terminal  of  the 
duct. 

Location  of  Terminals. — The  terminals  in  the  plenum  system  of 
ventilation  should  be  located  as  nearly  as  possible  in  the  breathing 
zone,  yet  they  should  be  so  placed  that  they  may  not  produce  drafts 
uncomfortable  to  the  occupants.  Terminals  at  the  floor  level  tend  to 
distribute  the  dust  contained  in  the  lower  air  strata,  and  also  in  cold 
weather  would  deliver  cold  air  around  the  feet  of  the  occupants  of  the 
spaces.  Consequently  this  location  of  terminals  is  undesirable. 

In  our  latest  ships  the  louvers  are  placed  at  a  level  of  about  three 
feet  above  the  deck,  and  the  air  current  is  directed  horizontally  to 
avoid  raising  dust  from  the  deck. 

In  certain  localities  where  insects  are  numerous  these  terminals 
should  be  screened  with  ordinary  screening  wire,  eighteen  meshes  to 
the  inch. 

In  large  cities  where  there  is  a  great  amount  of  dust  it  has  been 
found  advisable  to  interpose  between  the  intake  and  supply  fan  one 
of  the  several  forms  of  air  washers,  thus  freeing  the  air  of  its  dust  con- 
tent, and  likewise  humidifying  it  before  distributing  throughout  the 
building. 

It  will  be  observed  that  in  the  plenum  system  provision  is  made 
for  supplying  fresh  air,  but  the  vitiated  air  is  left  to  escape  through  the 
natural  openings  in  the  building. 

2.  The  exhaust  system  is  a  reversal  of  the  above  described  plenum 
system.     Instead  of  supplying  fresh  air  and  allowing  it  to  escape 
through  natural  openings,  the  exhaust  system  withdraws  the  vitiated 
air  from  the  building,  discharges  it  into  the  outer  air,  and  makes  no 
provision  for  admission  of  fresh  air  except  as  it  may  come  in  through 
natural  openings  to  take  the  place  of  the  withdrawn  foul  air. 

This  system  possess  disadvantages  and  should  be  employed  alone 
only  in  places  where  great  heat,  humidity,  injurious  gases  and  dust  or 
disagreeable  odors  should  be  removed. 

Instead  of  delivering  fresh  air  into  the  compartments  the  exhaust 
system  tends  to  draw  into  the  compartment  any  foul  air  which  may  be 
in  the  vicinity  of  the  natural  openings  of  the  chamber. 

3.  The    Combination   of   Plenum   and   Exhaust  Systems.— The 
combination  of  plenum  and  exhaust  systems  appears  to  be  the  ideal, 
as  the  plenum  fan  supplies  the  fresh  atmospheric  air  and  the  properly 


VENTILATION  63 

located  exhaust  fan  withdraws  the  vitiated  air  from  the  building,  thus 
maintaining  a  constant  supply  of  fresh  air  in  gentle  motion. 

Aboard  Ship. — Ships  spend  the  major  portion  of  their  time  in  atmos- 
pheric air  of  exceptional  purity;  despite  this  fact  natural  ventilation 
is  totally  inadequate,  because: 

(a)  The  wind  is  inconstant; 

(b)  Sufficient  natural  openings  are  incompatible  with  the  necessary 
strength  of  the  hulls  and  deck; 

(<:)  Rough  weather  at  sea  causes  closure  of  natural  openings  in 
order  to  exclude  water; 

(</)  To  deliver  sufficient  fresh  air,  ducts  would  have  to  be  too 
large,  too  heavy,  and  too  expensive.  Consequently  artificial  ventila- 
tion must  be  employed. 

As  on  shore,  the  three  systems  of  mechanical  ventilation  are  used, 
namely,  plenum,  exhaust,  or  the  combination  of  the  two.  The  neces- 
sity for  the  maintenance  of  integrity  of  water-tight  bulkheads  on  board 
ship  modifies  very  materially  the  artificial  ventilation  of  ships,  and  since 
these  bulkheads  should  not  be  pierced  below  the  waterline  beyond 
imperative  necessities,  it  is  impossible  to  employ  a  single  ventilating 
system  of  ducts  in  the  living  spaces,  as  flooding  of  one  compartment 
probably  would  result  in  the  flooding  of  others  through  the  ventilating 
ducts.  Each  water-tight  compartment  must  have  its  individual  system 
of  artificial  ventilation.  It  must  have  its  intake,  its  distributing  fan, 
and  ducts  leading  therefrom.  The  intake  for  the  fan  should  be  located 
in  the  superstructure  where  the  high  seas  of  a  gale  will  not  affect  the 
ventilating  system. 

In  determining  the  quantity  of  air  required  in  ;i  given  compartment  the  following 
factors  should  be  considered: 

1.  The  number  of  occupants; 

2.  The  character  of  activity  of  occupants,  whether  sleeping,  resting,  or  engaged 
in  arduous  work; 

3.  The  location  of  the  compartment  with  reference  to  engine  room,  fire  room, 
and  hot  spaces; 

4.  Exposure    of    boundaries   of   the   compartment    to    weather.     Obviously    an 
inner  compartment  will  require  greater  supply  than  one  which  may  have  an  opening 
into  external  air; 

5.  Whether  the  vessel  is  designed  specially  for  tropical  service; 

6  The  probable  generation  of  excessive  heat;  the  presence  of  great  humidity  or 
of  gaseous  pollutions; 

7.  Location  and  effect  of  openings  into  the  compartment  upon  the  contained  air. 


64  NAVAL  HYGIENE 

So  important  is  the  subject  of  ventilation  considered  in  the  British 
Navy  that  one  commissioned  officer  is  detailed  as  Ventilation  Officer. 
This  officer  may  or  may  not  be  the  senior  medical  officer.  If  not, 
he  is  required  to  keep  in  close  touch  with  the  senior  medical  officer  in 
order  that  the  best  results  may  be  obtained  from  careful  supervision 
and  nice  adjustment  of  the  ventilating  apparatus. 

The  plenum  system  combined  with  natural  exhaust  should  be  used 
on  board  ship  in  every  compartment  where  it  becomes  necessary  to 
supplement  natural  ventilation,  except  in  cases  where  there  are  great 
heat  or  great  humidity,  deleterious  gases,  bad  odors,  or  possible  infec- 
tions. The  exhaust  system  should  be  employed  in  such  circumstances. 
The  plenum  system  would  tend  to  force  foul  air  and  bad  odors  from  the 
compartment  in  which  they  were  generated  to  adjacent  compartments, 
and  here  we  would  see  the  paradoxical  effect  of  a  purifying  stream  of  air 
causing  pollution  of  air  contained  in  the  nearby  spaces.  In  an  engine 
room,  laundry,  steering  engine  room,  and  in  other  heated  compartments, 
the  exhaust  system  of  ventilation  should  be  employed  for  removal 
of  over-heated  air,  or  should  be  connected  with  the  smoke-pipe  casing. 
In  wash  room,  firemen's  wash  rooms,  and  the  various  water  closets  the 
exhaust  system  should  be  installed.  The  isolation  ward  should  be 
equipped  with  a  strong  exhaust  system,  having  communication  with 
no  other  compartment.  There  are  certain  compartments  on  board 
ship,  such  as  a  central  station  and  sound-proof  telephone  booths,  which 
should  be  well  supplied  with  plenum  ventilation. 

Whether  the  supply  or  exhaust  system  be  employed,  sufficient 
openings  in  the  ducts  should  be  provided  to  enable  their  thorough 
cleaning.  A  considerable  amount  of  dust  and  lint  accumulates  in  the 
air  trunks  in  a  very  short  time  and  may  be  distributed  generously 
throughout  the  ship  by  changes  in  rate  of  fan  and  jarring  incident 
to  gun  fire.  Dead  insects  often  are  found  in  these  trunks. 

Unless  intakes  are  screened  carefully  against  flies  and  mosquitoes, 
the  ventilating  system  may  be  an  active  factor  in  distributing  living 
insects  between  decks,  if  the  ship  happens  to  be  lying  in  a  region  in- 
fested with  them.  In  such  circumstances  it  is  not  uncommon  to  find 
numbers  of  insects,  some  dead,  some  injured,  lying  on  the  deck  near 
the  outlet  of  the  duct  supplying  fresh  air. 

During  the  summer  of  1915,  while  the  "North  Dakota"  was  lying  at  the  Navy 
Yard,  Philadelphia,  I  saw  an  1 8-inch  intake  on  the  forecastle  almost  wholly  oc- 
cluded by  a  layer  of  mosquitoes  and  moths.  In  some  places  this  layer  was  }>$  inch 


VENTILATION  65 

thick.  The  intake  had  been  screened  to  prevent  entrance  of  insects.  A  standing 
light  on  deck  near  the  intake  had  attracted  the  insects  to  within  the  sphere  of  in- 
fluence of  the  fan,  where  they  were  held,  many  dead  and  some  living,  by  the  aspirat- 
ing effect  of  the  fan  which  was  drawing  in  fresh  air. 


FlG.  19. — The  sereened  mouth  of  a  large  ventilating  intake  almost  completely 
occluded  by  mosquitoes  and  other  insects.  The  suction  of  the  powerful  fan  held 
the  insects  against  the  screen  until  a  layer  almost  a  half  inch  thick  had  been  accumu- 
lated. 

Intakes  for  fresh  air  which  are  near  the  butcher  shop,  galley,  or 
vegetable  lockers  on  deck  should  always  be  screened.  Decomposing 
vegetable  matter,  such  as  onions,  potatoes,  beets  and  cabbage,  form 
excellent  breeding  places  for  flies,  and  unless  the  openings  are  screened 


66 


NAVAL   HYGIENE 


the  ventilating  system  may  carry  young  flies  down  into  the  fan  chamber, 
whence  they  may  be  distributed  in  the  spaces  below. 

In  time  of  target  practice  or  in  action  the  plenum  ventilating  system 
may  prove  to  be  a  distributor  of  dangerous  gases  of  combustion.     Of 


r 


FIG.  20. 


).  lockers  on  d< 


course  the  quality  of  these  gases  is  dependent  upon  the  chemical  com- 
position of  the  explosives  used.  It  becomes  especially  necessary  to 
consider  methods  of  protection  against  gas  shells.  These  are  missiles 
containing  compressed  noxious  gases,  which  shells  explode  at  time  of 
impact  and  liberate  their  poisonous  content. 


VENTILATION  67 

During  the  Russo-Japanese  War  the  danger  of  gas  poisoning  became 
prominent. 

In  the  battle  of  Jutland  it  became  necessary  to  stop  the  supply 
fans  of  the  ventilating  system  in  order  to  prevent  delivery  to  the  spaces 
below  of  poisonous  gases  arising  from  gun  fire  and  from  gas  shells. 

The  ventilation  committee  appointed  by  the  British  Admiralty, 
after  a  careful  study  of  artificial  ventilation  on  board  ship,  has  recom- 
mended a  new  system  of  trunks  and  terminals  with  a  view  to  reduce 
the  drafts  and  to  distribute  evenly  the  supply  of  fresh  air  forced  through 
the  ventilation  system  by  fans. 

Fleet  Surgeon  R.  C.  Munday,  R.  N.  (British  Medical  Journal,  No.  2939,  p.  538) 
give-  the  following  brief  and  interesting  description: 

The  principle  of  the  new  system  which  has  now  been  adopted  in  our  most  recent 

battleships  and  cruisers  is  that  by  means  of  an  adjusted  deflector  projecting  into  the 

air  duct  a  limited  flow  of  air  is  directed 

C" <    Q —     into  a  large  number  of  outlet  gratings. 

^ Y  It  was  found  that  with  a  suitable  but 

—     ItUWiltitiWI verv   simPle   an(l   inexpensive   form   of 

j.-  „ ,    2  j  grating  the  air  passes  out  through  it  with 

a  fairly  uniform  velocity  at  all  parts.    As, 

howi  •  ver,  the  area  of  the  grating  is  considerable  in  proportion  to  the  air  allowed  to  issue 
through  it,  the  velocity  of  the  issuing  air  is  low,  and  no  unpleasant  draught  is  percepti- 
ble at  more  than  a  foot  away,  even  when  100  cubic  feet  of  air  a  minute  are  issuing 
froir  a  grating  of  18  by  6  inches.  The  grating  is  made  of  expanded  steel,  and  it  was 
found  that  a  three-eighths  of  an  inch  mesh  placed  so  that  its  direction  tended  to 
deflect  the  air  at  right  angles  to  the  trunk  thus: 

Fur.  21  produced  the  best  effect  at  a  minimum  of  cost  and  weight.  An  endeavor 
was  then  made  by  varying  the  curvature  of  the  deflector  to  obviate  the  inequality 
of  distribution  over  the  face  of  the  grating,  and  experiments  were  made  with 
deflectors: 


:          2  (a)  Concave,  thus: 


PI 
IG. 


.  23  (6)  Straight,  thus: 


FIG.  24  (c)  Convex,  thus: 

FIGS.  22,  23,  and  24. — Sections  of  ventilating  ducts  which  were  the  subject  of 
experiment.  Baffle  plates  concave,  straight  and  convex  were  tried  at  the  louvers  or 
openings  in  the  ducts.  The  straight  baffle  plate  was  decided  to  be  most  satisfactory. 


68  NAVAL  HYGIENE 

The  distribution  of  the  air  was  found  to  be  a  function  of  (i)  the  velocity  of  the  air 
in  the  trunk  flowing  past  the  deflector;  (2)  the  amount  of  opening  of  the  deflector; 
(3)  the  shape  of  the  deflector. 

On  the  whole,  the  straight  deflector  proved  to  be  the  most  satisfactory  and 
was  adopted  in  all  subsequent  experiments;  and  for  gratings  in  the  proximal  end 
of  the  trunk  nearest  to  the  fan,  where  the  velocities  are  high  and  the  angle  of 
opening  of  the  deflector  small,  the  straightness  and  truth  of  the  deflector  is  of  great 
importance. 

As  each  deflector  takes  off  a  portion  of  the  air  flowing  along  a  uniform  trunk,  the 
velocity  of  air- flow  in  the  trunk  beyond  is  correspondingly  diminished;  and  since 
frictional  resistance  varies  as  the  square  of  the  velocity,  there  is  a  very  marked 
reduction  in  frictional  resistance.  So  important  is  this  effect,  that  it  was  found 
that  with  a  sufficient  number  of  deflectors  and  gratings  distributed  along  the 
sides  of  a  uniform  trunk  of  sufficient  length,  the  volume  of  air  delivered  was  93 
per  cent,  of  the  delivery  when  no  trunk  at  all  was  connected  with  the  delivery  side 
of  the  fan,  there  being,  however,  a  trunk  of  about  the  ordinary  length  and  size  on 
the  intake  side,  as  would  always  be  the  case  in  a  ship. 

The  deflectors  themselves  cause  no  material  resistance.  There  is  no  difficulty 
in  fixing  them  so  that  each  gives  practically  the  same  delivery  of  air,  a  simple 
formula  having  been  found  by  means  of  which  this  can  be  done  without  actual  trial. 
The  deflectors  remote  from  the  fan,  where  the  velocity  and  pressure  of  the  air  in 
the  trunk  are  small,  require,  of  course,  to  be  much  more  widely  open  than  those 
close  to  the  fan.  Suppose  the  number  of  deflectors  in  a  trunk  is  N,  then  the  amount 

of  opening  of  the  Rib.  deflector  will  be  ,,  _  „  ,      multiplied  by  the  width  of  the 

trunk,  thus,  for  example,  the  last  must  be  full  open,  the  last  but  one-half  open,  and 
so  on. 

In  a  new  ship  the  deflectors  are  first  adjusted  in  accordance  with  the  above 
formula,  and  then  with  the  fan  running  under  ordinary  conditions  each  delivery 
opening  is  examined  to  see  whether  the  velocity  of  air  current  is  approximately 
the  same  at  any  portion  of  the  trunk  proximal  or  distal,  and  the  deflectors  are 
adjusted  until  this  has  been  attained;  but  once  equality  of  velocity  has  been  se- 
cured the  deflectors  should  be  permanently  fixed,  so  that  unauthorized  persons  shall 
not  tamper  with  them  and  cause  too  great  a  draft  in  one  place  and  a  lack  of  air 
in  another. 

In  the  case  of  branch  pipes  it  was  found  best  to  place  a  deflector  at  the  junction 
and  so  control  the  delivery  through  the  whole  of  the  gratings  on  the  branch.  Each 
grating  on  the  branch  should  also  have  its  deflector.  It  was  also  found  that  it 
made  no  measurable  difference  to  the  amount  of  air  distributed  whether  the  branches 
came  off  at  right  angles  or  at  the  usual  angle  of  30  degrees. 

If  each  grating  measures  18  by  6  inches,  which  appears  to  be  a  convenient  size, 
one  is  required  for  every  two  men  when  50  cubic  feet  of  air  per  man  per  minute  is 
supplied.  This,  of  course,  means  a  considerable  number  of  gratings.  On  the 
other  hand,  the  arrangement  is  simple,  inexpensive,  and  efficient  in  preventing 
drafts  and  distributing  air  and  warmth  evenly  throughout  a  compartment. 
Very  favorable  reports  have  been  received  from  all  ships  so  fitted. 


VENTILATION 


As  emergency  measures,  portable  electric  blowers  may  be  employed, 
an  air-conducting  hose  being  led  along  the  deck,  or  better,  on  a  level 
above  the  deck.  The  hose  may  be  fenestrated,  thus  facilitating  air 
distribution. 


CHAPTER  VIII 
HEATING 

Heating  and  ventilation  are  interdependent  and  must  be  considered 
from  several  aspects,  not  the  least  of  which  is  economy  of  fuel  consump- 
tion. Each  time  the  warm  air  of  a  room  is  exchanged  for  cold  air 
heat  units  are  lost  in  proportion  to  the  temperature  differences. 

The  air  in  houses  usually  is  too  dry  and  hot.  Such  air  is  not  only 
disagreeable  to  breathe,  but  actually  parches  the  respiratory  mucosa 
and  irritates  it  to  a  degree  which  exposes  the  body  to  infecting  organisms 
which  lie  upon  the  epithelium  of  the  mucosa,  awaiting  a  solution  of  its 
continuity  in  order  to  gain  entrance  to  the  unprotected  tissues. 

Sixty-two  to  65°F.  is  most  comfortable  temperature  for  rooms  in 
which  relative  humidity  is  seventy.  When  relative  humidity  is  below 
this  figure  a  higher  temperature  is  necessary  because  of  the  rapid  evapo- 
ration from  the  body  surface  and  the  consequent  sense* of  chilling. 
This  evaporation  decreases  to  nil  as  the  air  approaches  saturation  with 
aqueous  vapor,  hence  a  proportionately  lower  temperature  is  required 
for  comfort. 

There  are  three  methods  of  heat  travel: 

1.  Radiation. — By  this  method  heat  rays  are  emitted  directly  in 
right  lines  from  the  heating  body.     As  one  stands  in  front  of  an  open 
fire  one  may  be  too  hot  in  front  and  too  cold  in  back  by  reason  of  the 
body's  intercepting  the  radiated  rays. 

2.  Conduction. — Heat  travelling  by  conduction  follows  the  con- 
tinuity of  a  heated  body.     A  cold  poker  thrust  into  the  fire  soon  be- 
comes heated,  not  alone  at  the  end  in  the  fire,  but  also  at  the  opposite 
end  which  has  become  hot  by  conduction. 

3.  Convection. — When  heat   travels  by  convection,  air  about  a 
heated  body  becomes  warm  and  rises.     Air  currents  thus  established 
are  convection  currents. 

There  are  seven  principal  methods  of  warming  air  for  human 
comfort: 

i.  Open  fires; 


2.  Stoves; 

3.  Gas  stoves  and  fires; 

4.  Hot  air; 

5.  Hot  water; 

6.  Steam; 

7.  Electricity. 

1.  Open  Fires. — The  most  expensive  method.     Notter  and  Firth 
claim  that  for  each  pound  of  coal  burned  2600  cubic  feet  of  air  pass 
up  the  flue.    This  interchange  of  air  causes  most  of  the  heat  generated 
by  open  fire  to  escape  up  the  chimney  as  warmed  air.     It  is  estimated 
(Harrington)  that  seven-eighths  of  the  heat  generated  by  open-grate 
fire  is  lost  up  the  chimney,  leaving  only  one-eighth  for  heating  purposes. 

Open  grates  act  by  radiation  principally,  and  while  they  make 
much  dust  and  do  not  warm  the  room  well,  they  are  of  much  value  in 
ventilating  the  compartments  in  which  they  are  placed.  The  best 
typ»e  is  one  in  which  fresh  air  enters  from  the  exterior  of  the  building 
and  comes  into  the  room  through  a  flue  at  the  back  of  the  grate,  thus 
being  heated  prior  to  its  entry  into  the  room. 

2.  Stoves. — Stoves  placed  in  the  center  of  the  room  are  a  very 
efficient  form  of  heating.     It  is  claimed  that  80  to  90  per  cent,  of  heat 
generated  by  this  method  is  utilized. 

Stoves  tend  to  parch  any  organic  dust  upon  them,  thus  imparting'a 
disagreeable  odor  to  the  air  in  the  room. 

When  red-hot,  carbon  monoxide  may  be  given  off  from  the  surfaces 
which  are  so  heated.  There  are  various  methods  of  applying  the  heat 
of  these  stoves. 

3.  Gas  Stoves  and  Fires. — Gas  stoves  and  fires  cause  considerable 
atmospheric  pollution  through  combustion  and  leaky  fixtures.     They 
are;  convenient,  clean,  and  free  of  dust, J)ut  cannot  be  regarded  as  an 
efficient  method  of  heating. 

4.  Hot  Air. — The  hot-air-furnace  system  consists  in  a  central  heating 
apparatus  in  which  air  is  heated  and  rises  through  hot-air  ducts  to  vari- 
ous openings  in  the  spaces  to  be  heated.     Usually  there  is  an  inlet  for 
cold  air  which  passes  into  the  heating  dome  (either  over  heated  plates 
or  tubes),  thence  over  a  water  basin  for  humidification.     These  basins 
are  very  small  and  receive  too  little  attention  as  a  rule.     This  results 
in  too  dry  air,  which  has  a  capacity  for  carrying  much  more  aqueous 
vapor,  consequently  the  woodwork  and  furniture,  etc.,  are  dried  and 
damaged.     But  worse  than  this  is  the  parching  effect  upon  the  skins 


72  NAVAL   HYGIENE 

and  mucous  membranes  of  the  occupants  of  rooms  heated  by  the  hot- 
air  method. 

5.  Hot  Water. — Hot  water  absorbs,  carries,  and  imparts  heat  well; 
hence  it  is  very'iiseful  for  heating  buildings.     The  hot  water  is  contained 
in  pipes  leading  to  heating  bodies  called  radiators  in  the  compartments, 
and  back  again  to  the  boiler  and  furnace. 

This  system  is  readily  controlled,  and  where  applicable  is  highly 
desirable.  The  air  is  too  dry. 

6.  Steam  Heating. — This   method,   while   tending   to   over-heat, 
is  commonly  used  in  our  country.     Steam  is  generated  from  a  cen- 
tral heating  boiler,  passes  to  radiators  through  steam  pipes,  through 
the  radiators  and  back  to  the  boiler  (ultimately  by  way  of  a  hot-water 
reservoir,  thus  saving  feed  water  and  heat  units). 

There  are  two  systems  of  steam  heating,  viz. : 
(a)  High  pressure; 
(£>)  Low  pressure. 

In  the  former  a  pressure  of  50  pounds  per  square  inch  is  carried 
in  the  pipes  and  radiators,  while  in  the  latter  the  pressure  is  carried 
at  7  to  10  pounds  and  the  pipes  are  not  built  to  sustain  the  tension 
of  steam  in  the  so-called  high-pressure  system. 

7.  Electricity.- — This  is  a  very  clean,  expensive  way  of  heating,  which 
method  may  readily  be  employed  in  small  rooms.     Resistance  coils  are 
placed  in  a  circuit  and  by  radiation  and  convection  the  temperature 
of  the  space  is  raised. 

Systems  of  heating  are: 

1.  Direct; 

2.  Indirect; 

3.  Direct-indirect. 

1.  In  the  direct  system  the  grate,  stove,  or  heating  body  is  directly 
within  and  actually  heating  the  room. 

2.  Indirect    System. — In    this    system    the    air    is    warmed    by 
steam  or  hot  water  heated  in  boilers  centrally,  and  delivered  to  the 
compartments. 

3.  Direct-indirect  System. — The  heating  body  is  within  the  space 
to  be  heated,  atmospheric  air  is  drawn  into  contact  with  the  heating 
body,  heated  by  it  and  then  passes  out  into  the  room. 

The  advantages  of  a  central  heating  system  are: 
i.  The  service  is  simpler.     Many  rooms  are  provided  for  with  only 
one  furnace; 


a.  Fuel  does  not  have  to  be  taken  to  each  room,  nor  does  it  have  to 
be  carried  to  upper  floors; 

3.  Combustion  is  easier  to  supervise  and  regulate.     Heat  expendi- 
ture is  less; 

4.  Living  rooms  are  kept  free  of  ash,  smoke,  soot,  etc. ; 

5.  Corridors  and  staircases  are  more  economically  heated; 

6.  An  even  temperature  is  possible  for  the  entire  house. 
The  disadvantages  are: 

r.  Initial  cost  is  expensive; 

2.  Requires  a  skilled  attendant; 

3.  Mistakes  in  installation  are  difficult  to  rectify; 

4.  Necessary  repairs  cause  the  whole  building  to  be  without  heat; 

5.  In  the  hot-water  system  there  is  danger  of  radiators  freezing  if 
the  window  above  them  is  left  open  at  night. 

Heating  aboard  ships  today  is  essentially  by  (a)  steam,  or  by  (b) 
electricity.  Formerly  it  was  by  hot  shot,  and  later  by  stoves.  On  battle 
ships  and  larger  ships  generally  living  spaces  are  heated  by  steam  under 
the  high-pressure  system,  known  as  the  "  thermoventilating "  system. 

Air  is  taken  in  by  fans  through  cowls,  passes  through  a  thermo-tank 
where  it  is  exposed  to  steam  coils,  and  after  being  heated  is  forced 
thence  into  the  various  living  spaces. 

This  air  is  not  humidified  and  on  the  U.  S.  S.  Arkansas  I  have  seen 
air  outside  at  temperature  well  below  32°F.  taken  in,  heated  to  above 
i2o°F.,  and  delivered  to  living  spaces! 

The  following  report  on  the  heating  system  of  the  U.  S.  S.  Arkansas 
was  made  by  me  in  1915: 

The  ventilation,  however,  cannot  be  considered  independently  of  the  heating 
syst:em  since  fresh  air  is  taken  in  by  the  blowers,  heated  (when  necessary)  by  passing 
over  steam  coils,  and  then  delivered  by  blowers  through  ducts  to  the  various  com- 
partments, entering  through  the  McCreery  or  other  terminals.  This  combined 
ventilating  and  heating  system  is  far  from  satisfactory.  During  winter  weather 
fresh  air  is  taken  in  at  low  temperature  and  capable  even  at  saturation  of  carrying 
a  comparatively  small  amount  of  water  vapor.  This  air  is  heated  (and  expanded), 
thereby  greatly  reducing  the  relative  humidity  of  air  finally  supplied  to  the  living 
spaces.  For  instance,  even  if  air  were  saturated  at  4o°F.  it  would  contain  2.86 
grains  of  water  (vapor)  per  cubic  foot,  and  when  heated  to  7o°F.,  at  which  tem- 
perature the  air  is  capable  of  holding  8.01  grains  per  cubic  foot,  ceteris  paribus, 
this  air  would  have  a  relative-  humidity  of  36  per  cent.,  whereas  the  desideratum  is 
about  twire  that  amount,  viz.,  70  per  cent.  Expired  air  is  saturated  for  its  tem- 
perature, say  Q80F.,  and  is  carrying  about  18.9  grains  of  water  vapor  per  cubic 


74  NAVAL  HYGIENE 

foot.     The  saturation  deficit  must  be  supplied  by  the  respiratory  mucous  tract  and 
much  dryness  and  irritation  of  the  sinuses  and  respiratory  tract  result. 

Air  from  a  louver  in  the  wardroom  country  has  been  observed  by  me  to  be 
delivered  at  i2o°F.  dry-bulb  (i.e.,  the  thermometer  scale  would  register  no  higher, 
but  the  mercury  went  the  limit),  while  the  wet-bulb  thermometer  mounted  on  the 
same  board  registered  7o°F.  Some  method  of  humidification  of  the  air  so  heated 
should  be  devised  in  order  to  reduce  the  headaches,  and  nasal  and  bronchial 
irritation  caused  by  the  too-dry  air. 

The  specifications  for  construction  of  battle  ships'  heating  plants 
call  for  ability  of  the  system  to  maintain  a  temperature  of  7o°F.  in  the 
living  spaces  when  temperature  of  external  air  is  o°F.;  air  being 
delivered  full  capacity  and  heated — 72,000  cubic  feet  per  minute. 

In  certain  isolated  spaces  where  the  ducts  of  the  thermo-tank  system 
cannot  be  carried  radiators  are  installed.  These  are  of  the  high-pressure 
variety  and  the  pipes  not  uncommonly  are  led  on  the  deck  in  the  angle 
between  the  deck  and  the  vertical  bulkheads  and  are  covered  by  appro- 
priate gratings.  Too  commonly  these  pipes  and  gratings  are  the  sites 
for  accumulation  of  much  dust  unless  they  are  carefully  tended. 

Where  long  and  independent  leads  of  supply  and  exhaust  would 
be  required  electric  heaters  are  authorized. 

Steam  radiators  on  the  new  battleships  are  to  supply  heat  to  50 
to  100  cubic  feet  of  air  per  square  foot  of  radiator  surface,  depending 
upon  the  location  and  requirements,  e.g.,  bathrooms  on  a  deck 
already  well  heated  would  be  allotted  100  cubic  feet  per  square  foot  of 
radiator  surface,  while  the  chart  house,  exposed  high  on  the  bridge,  not 
surrounded  by  heated  spaces,  would  be  given  50  cubic  feet  per  square 
foot  of  radiator  surface. 

In  submarines  electric  heating  is  employed  and  required  to 
maintain  a  temperature  in  the  boat  i5°C.  higher  than  the  sea  water 
in  which  the  boat  lies. 

In  presence  of  possible  explosive  mixtures  of  hydrogen  and  air  and 
of  gasoline  it  is  desirable  to  have  no  open  flame  to  vitiate  air  or  cause 
explosion.  Hence  electricity  lends  itself  well  to  the  purpose  of  heating 
submarines. 

Finally  any  system  of  heating  must  be  operated  intelligently.  If 
it  is  designed  to  operate  with  certain  hatches  closed  or  certain  doors 
opened,  it  scarcely  can  be  expected  that  it  will  operate  successfully 
with  a  reversal  of  these  conditions. 

The  thermo-tank  system  has  certain  objectionable  features.     It  is  a 


system  which  combines  heating  and  ventilation.     Air  is  warmed  and 
dried  but  not  humidified. 

The  system  is  difficult  to  control,  since  one  compartment  may  be 
too  hot  while  another  is  too  cold.  Cutting  off  heat  from  the  former 
renders  the  latter  still  less  comfortable.  Until  independent  heating 
and  aeration  can  be  accomplished  conditions  will  remain  unsatisfac- 
tory and  insanitary. 


CHAPTER  IX 
WATER 

Water  is  a  fluid  composed  of  two  parts  hydrogen  and  one  part 
oxygen,  and  probably  exists  in  a  pure  state  only  as  a  laboratory 
curiosity. 

PHYSICAL  PROPERTIES 

Pure  water  is  transparent,  odorless,  tasteless,  and  almost  colorless 
at  ordinary  temperature  and  pressure.  It  is  not  absolutely  colorless. 
It  has  a  slightly  bluish  tinge  under  normal  conditions. 

Water  boils  at  2i2°F.  or  ioo°C,  and  freezes  at  32°F.  or  o°C.  at 
standard  barometric  pressure,  and  is  almost  incompressible. 

At  the  freezing  point  water  rapidly  expands  and  when  frozen  solid 
has  increased  by  about  one-eleventh  of  its  original  volume. 

The  temperature  at  which  water  boils  varies  directly  with  atmos- 
pheric pressure,  falling  as  pressure  is  diminished. 

Water  has  great  power  as  a  solvent  and  in  nature  its  contact  with 
various  chemicals  forms  acid  or  alkaline  solutions  which  are  constantly 
changing — slowly,  but  no  less  surely — the  broad  face  of  Nature. 

Solution  of  gases  is  a  property  of  water  and  it  is  to  this  property, 
in  part,  that  the  palatability  of  potable  water  is  due,  viz.,  the  aeration, 
or  absorption  of  atmospheric  air. 

The  gaseous  content  of  water  is  driven  off  by  boiling  which  produces 
a  flat,  or  almost  "oily"  taste.  Boiled  water  readily  may  be  restored 
to  its  original  state  of  potability  by  agitation  in  the  air. 

Man's  Needs. — Man  needs  daily  a  half  ounce  of  water  per  pound 
of  body  weight  for  internal  use.  Obviously  the  needs  vary  with  his 
habits  and  work. 

Water  constitutes  more  than  two-thirds  by  weight  of  the  human 
body,  even  the  teeth  containing  10  per  cent,  water;  and  when  it  is 
remembered  that  man  must  depend  upon  water  for  alimentation, 
and  that  the  tissues  are  constantly  being  bathed  in  a  fluid,  the  chief 

76 


WATER  77 

constituent  of  which  is  water,  it  will  be  realized  that  next  to  air,  water  is 
necessary  to  human  existence.  A  man  weighing  150  pounds  has  a 
water  content  weighing  100  pounds.  The  loss  of  one-tenth  of  this 
fluid  content  is  dangerous,  i.e.,  10  pounds  or  about  i  gallon. 

Without  water  as  food  or  drink  it  is  doubtful  if  the  strongest  man 
can  survive  for  a  period  of  five  days.  The  male  adult  consumes  as  food 
and  drink  from  60  to  100  fluid  ounces  daily.  Women  require  somewhat 
less.  Marching  men  require  i  quart  of  water  for  every  7  miles  cov- 
ered by  them,  and  even  more  in  hot  weather. 

The  amount  of  water  ingested  will  vary  with  the  diet,  work,  season, 
temperature,  condition  of  the  alimentary  tract,  psychic  or  emotional 
state,  hygrometric  state  of  the  atmosphere,  and  certain  diseases. 

The  sum  total  of  water  which  the  inhabitants  of  a  city  need  to 
drink  in  no  way  represents  the  daily  requirements  of  that  community. 
Much  is  needed  for  baths,  sewerage,  laundry,  and  domestic  animals, 
as  well  as  the  industries,  etc.  In  cities  it  is  estimated  that  if  possible  a 
minimum  of  50  gallons  per  day  per  capita  should  be  allowed.  Pitts- 
l)ii  -<i\i  has  250  gallons. 

For  one  reason  or  another  the  per  capita  supply  of  water  consumed 
by  many  cities  is  smaller  than  the  above-mentioned  minimum;  e.g., 
Berlin  is  said  to  use  15^  gallons  per  capita,  Vienna  22,  London  2%%, 
Paris  44,  Glasgow  50. 

Hospitals  require  a  much  larger  supply  of  fresh  water.  The  per 
capita,  supply  should  be  unlimited.  Where  unlimited  supply  is  not 
available  the  per  capita  allowance  should  be  as  little  below  100  gallons 
as  the  supply  will  permit. 

Water  Aboard  Ship. — On  board  ship  distilled  water  is  supplied  for 
drinking,  cooking,  and  usually  for  bath  and  laundry  purposes.  This 
water  is  often  distilled  from  fresh  feed  water  taken  aboard  from  hy- 
drants at  the  dock  or  from  water  boats.  Manifestly  the  purity  of  this 
water  may  be  questioned.  Distillation  renders  it  pure. 

In  time  of  war,  when  coal  consumption  must  be  considered,  distilla- 
tion may  not  be  practised.  If  the  water  cannot  be  distilled  it  should  be 
chlorinated. 

Chlorination  should  be  done  as  soon  as  the  water  is  taken  aboard 
and  repeated  just  before  the  water  is  used  for  drinking.  This  would 
pro  vent  the  result  of  possible  bacterial  infection  by  an  enemy.  The 
second  chlorination  probably  would  be  unnecessary  if  the  drinking 
water  tanks  are  under  proper  bacteriological  supervision. 


NAVAL  HYGIENE 


When  steaming  at  sea  the  fresh  water  supply  must  come  from 
"over  the  side,"  i.e.,  salt  water  is  distilled. 


FIG.  25. — A  diagram  showing  general  plan  of  the  apparatus  used  for  distilling 
salt  water  on  board  ship.  The  salt  water  is  evaporated  by  means  of  steam  coils 
which  pass  through  it.  The  vapor  is  then  distilled,  being  cooled  by  passing  around 
pipes  in  which  cold  salt  water  is  circulating.  (Gatewood.) 

At  sea  the  distillate  is  pure  except  that  the  water  may  taste  of  chlo- 
rine (as  salt)  or  of  oil  from  the  machinery  (as  the  result  of  leaky  tubes 
in  evaporators  or  condensers). 


Sudden  incre 


WATER 


79 


idden  increase  in  saline  content  of  distillate  should  never  be  ignored. 
The  cause  is  frequently  a  leaky  tube.  If  the  sea  water  be  taken  from 
well  off  shore,  e.g.,  100  miles,  such  a  leak  means  little  except  that  the 
drinking  water  shows  more  salt  than  usual.  This  is  in  such  small 
quantity  that  it  is  not  apt  to  do  more  than  render  the  water  a  little 
less  palatable.  Such  a  leak,  however,  occurring  when  the  ship  is  lying 
in  a.  sewage  polluted  harbor,  is  a  much  more  serious  matter,  as  the 
health  of  the  personnel  may  be  menaced. 


I"i  i    may   be   seen   lying  upon   bare   wood 

which  may  not  have  been  thoroughly  dry. 

There  is  no  evidence  that  pure  distilled  water  is  harmful  to  man. 
Some  have  claimed  it  is.  Kxperienre  has  proved  their  claim  untrue. 

A  system  of  salt  water  is  distributed  over  ships  for  flushing  closets, 
baths,  in  pantries.  Tire  main-,  etc.  In  harbors  this  may  be  a  grave 
menace,  as  is  apt  to  be  the  washing  of  decks  with  such  water.  Espe- 
cially is  this  true  of  washing  mess  tables.  Tables  wetted  down  seldom 
ha\e  time  to  dry  thoroughly  before  they  are  needed  for  the  next  meal. 


So 


NAVAL  HYGIENE 


As  they  are  not  covered,  it  is  easy  to  see  that  the  table  surface,  moist 
with  polluted  water,  is  apt  to  infect  a  slice  of  bread  which  will  absorb 
moisture  and  infection  like  a  blotter. 

Salt  water  in  a  pantry  must  be  regarded  as  a  menace.  Careless 
servants  may  rinse  dishes  in  harbor  water  badly  contaminated  with 
sewage.  Likewise  in  baths  care  must  be  taken  that  salt  water  is  not 
used  in  harbors. 


FIG.  27. — A  sketch  showing  how  fresh  water  may  be  contaminated  by  salt 
water  if  the  two  systems  discharge  at  a  common  opening.     (Gate-wood.) 

Fabrics,  decks,  etc.,  thoroughly  wetted  in  salt  water  seldom  if  ever 
become  dry  thereafter  unless  they  are  thoroughly  washed  in  fresh 
water,  for  the  salt  deposited  in  the  fabric  or  wood,  being  hygroscopic, 
never  parts  wholly  with  its  water  in  ordinary  conditions  until  the  salt 
is  washed  out. 

Bathing  and  scrubbing  in  water  from  over  the  side  of  the  ship 
should  be  discouraged,  except  at  sea  where  water  is  probably  free  of 


pollution  if  taken  from  beyond  the  sphere  of  influence  of  the  ship's 
sewage  pipes. 

Distilled  water  is  highly  desirable,  if  expensive,  for  laundry  purposes. 
If  the  water  distilled  from  the  sea  contains  considerable  chloride  or 
sulphate  content  it  will  prove  unsatisfactory,  being  too  "hard"  for 
laundry  use. 

Storage  of  Water  on  Ships. — When  water  is  distilled  or  is  received 
for  storage  on  board  ship  it  is  placed  in  large  steel  compartments  or 
tan  vs  which  are  entered  by  manholes.  The  water  enters  the  tank 
through  pipes  from  pumps  and  leaves  the  tank  through  discharge  pipes 
for  distribution  to  the  several  smaller  gravity  tanks,  which  give  "head" 
or  pressure  to  the  water  as  it  goes  to  the  fixtures. 

From  this  it  will  be  seen  that  distilled  water  goes  directly  from  the 
distilling  plant  into  the  storage  tanks,  remains  there  for  storage,  cooling 
and  aeration,  and  thence  goes  to  the  fixtures  for  drinking  and  washing 
purposes. 

In  this  process  there  is  no  opportunity  for  infection  as  the  water  is 
not  exposed  from  the  time  it  leaves  the  distillers  until  it  reaches  the 
fixtures. 

The  tanks  are  coated  on  the  interior  with  bitumastic  to  prevent 
rusting. 

After  heavy  weather  in  which  the  water  in  the  tanks  becomes 
greatly  agitated  iron  rust  is  apt  to  appear  in  suspension,  but  this  is  not 
harmful. 

When  it  becomes  necessary  to  clean  the  tanks  they  should  be  entered 
through  manholes  on  the  sides  rather  than  on  the  top  of  the  tank. 
In  this  way  dust  collecting  on  top  of  the  tank  is  not  likely  to  gain 
entrance. 

Carriers  of  disease  should  not  be  permitted  to  enter  the  tanks  for 
purposes  of  cleaning,  and  clean  rubber  boots  and  fresh  clean  clothing 
should  be  worn  by  all  entering  the  tanks  for  work. 

After  the  tanks  have  been  thoroughly  scrubbed  with  soap  and  water 
and  rinsed  with  disinfecting  solution  if  necessary,  they  should  be  rinsed 
with  fresh  water.  A  steam  hose  should  then  be  led  into  the  tank  in 
order  to  steam  it  thoroughly  before  permitting  the  entrance  of  freshly 
distilled  water. 

Unless  the  medical  officer  exercises  careful  supervision  over  the 
(leaning  of  the  tanks  they  readily  may  become  infected. 

Water  enters  these  tanks  from   the   distillers  at  a   temperature 


82  NAVAL   HYGIENE 

approximating  90°  to  ioo°F.  in  temperate  climates  and  even  so  much 
as  i8o°F.  in  the  tropics.  Obviously  many  factors  influence  the  tem- 
perature of  the  distillate,  but  in  the  tropics  and  probably  a  fair  propor- 
tion of  the  time  in  temperate  climates,  the  distillate  will  enter  the  tanks 
at  a  temperature  almost  equal  to  that  at  which  milk  is  pasteurized. 

When  water  from  on  shore  is  introduced  directly  into  the  drinking  tanks  (and 
this  should  not  be  done  if  it  can  be  avoided)  it  often  happens  that  the  confinement 
of  the  water  in  a  warm  temperature  between  decks  results  in  decomposition  of 
organic  matter  with  a  very  foul  odor  resulting.  At  times  water  is  taken  from 
streams  grossly  polluted  with  organic  matter,  as  for  instance  when  salmon  are  run- 
ning. The  fish  impelled  by  spawning  instinct  swim  from  salt  water  up  stream  into 
fresh  water,  generally  so  far  as  the  first  insurmountable  waterfall.  They  go  in 
schools  and  at  times  are  so  numerous  that  the  water  is  seriously  polluted  by  the 
decomposing  flesh  of  injured  fish  and  by  their  excretions. 

I  have  seen  water  taken  on  board  ship  from  a  stream  in  Alaska  in  which  salmon 
were  running.  This  water  was  taken  contrary  to  advice  of  medical  officer,  as  it 
seemed  expedient  to  get  fresh  water  at  this  place.  Within  forty-eight  hours 
the  odor  of  decomposition  coming  from  the  water  tanks  was  so  great  as  to  render  the 
water  disgusting.  It  could  not  be  drunk  and  the  foul  odor  pervaded  the  various 
compartments  in  the  vicinage  of  the  tanks.  It  was  necessary  to  empty  the  tanks 
and  thoroughly  cleanse  them  before  pure  water  could  be  put  into  them  again. 

Sea  Water. — Sea  water  contains  proportions  of  saline  constituents 
varying  in  concentration  with  the  portion  of  the  globe  washed  by  that 
part  of  the  sea  under  examination. 

The  Atlantic  Ocean  contains  about  35,900  parts  of  salt  per  million, 
the  salts  and  proportions  being  as  follows: 

Sodium  chloride 28,032  parts  per  million 

Potassium  chloride 791  parts  per  million 

Magnesium  chloride 3>34J  parts  per  million 

Magnesium  sulphate 2>I9I  parts  per  million 

Calcium  sulphate 1,4*2  parts  per  million 

Magnesium  bromide 75  parts  per  million 

Calcium  carbonate 50  parts  per  million 

Ferrous  carbonate 5  parts  per  million 

Magnesium  nitrate 2  parts  per  million 

Ammonium  chloride  and  traces  of  magnesium  carbonate,  lithium 
chloride,  and  silica  are  found. 

It  will  be  observed  from  the  above  that  sea  water  is  permanently 
hard. 


WATER  83 

I  'sable  water  should  be  not  over  3.5  degrees  hardness  (Clark  scale  or 
50  parts  per  million)  while  sea  water  is  431  degrees  hardness  (Clark 
scale  or  6157  parts  per  million). 

Water  on  Shore.- — As  naval  forces  often  operate  ashore,  water  on 
shore  should  be  considered. 

For  convenience  of  description  water  may  be  classified  into  the 
following  varieties,  viz.: 

1 .  Meteoric  water — rain,  snow,  hail,  sleet,  frost,  dew. 

2.  Surface  water — rivers,  lakes,  ponds. 
;•;.  Ground  water — subsoil  water. 

£.  Deep-well  water — artesian  water. 

r.  Meteoric  water  or  rain,  etc.,  is  the  chief  source  of  fresh  water 
supply.  Surface,  ground  and  artesian  waters  are  all  modifications  by 
environment  of  meteoric  water. 

Owing  to  its  property  of  gas  absorption  rain  water  will  absorb 
mary  of  the  gases  which  pollute  the  air  during  its  precipitation,  conse- 
quently it  may  be  said  that  the  purity  of  meteoric  water  varies  with  the 
purity  of  the  atmosphere  through  which  it  falls. 

Therefore,  if  the  air  be  polluted  with  human  excreta  and  exhalation; 
with  gases  of  decomposition  of  animal  and  vegetable  matter;  with  dust 
or  bacteria;  or  the  mechanical  or  chemical  products  of  the  industrial 
activities;  the  rain  water  may  be  expected  to  give  evidence  thereof. 

It  is  stated  that  rain  water  absorbs  25  c.c.  of  gases  per  liter  from  the 
air.  This  volume  is  composed  of  34  per  cent,  oxygen,  64  per  cent, 
nitrogen  and  2  per  cent,  carbon  dioxide. 

Traces  of  ammonia  may  be  found  and  this  will  increase  as  the  rain 
cloud  moves  from  country  or  sea  toward  urban  centers  where  the 
air  contains  nitrites,  nitrous  and  nitric  acids,  sulphurous  acid,  soot, 
bacteria,  etc. 

Near  the  sea  meteoric  water  is  apt  to  contain  salts  from  the  sea 
itself. 

When  meteoric  water  reaches  the  earth  some  of  it  gradually  finds  its 
wax  into  rivers,  streams,  lakes,  etc.,  and  becomes  the  surface  water  of 
our  classification;  some  percolates  until  it  reaches  the  first  impermeable 
stratum  and  becomes  subsoil  or  ground  water;  while  some,  falling 
between  outcroppings  of  impermeable  strata,  percolates  to  and  runs 
along  the  deeper  impermeable  stratum  and  gives  to  us  artesian  water; 
and  lastly  some  of  this  rain  water  is  evaporated,  as  result  of  winds  and 
temperature,  into  the  atmosphere,  again  to  make  up  its  saturation 


84  NAVAL   HYGIENE 

deficit.     It  is  estimated  that  about  50  per  cent,  of  meteoric  water  thus 
is  returned  to  the  amosphere. 

There  is  a  marked  variation  in  annual  rainfall  in  different  parts  of 
the  world,  from  the  desert  to  the  places  where  rainfall  is  almost  un- 
believably great,  amounting  to  600  or  800  inches  in  Assam. 

2.  Surface  water  is  chiefly  composed  of  the  rainwash  of  the  earth's 
surface  and  of  objects  resting  upon  it. 

Surface  waters  may  be  standing  or  flowing,  depending  upon  natural 
or  artificial  barriers,  consequently  it  is  found  in  lakes,  ponds,  streams, 
and  rivers. 

It  is  evident  that  surface  water  will  take  its  character  from  the 
watershed  upon  which  it  falls  and  runs;  hence  it  maybe  pure  or  polluted ; 
alkaline  or  acid;  clear  or  turbid;  odorless  or  foul-smelling;  colorless  or 
colored;  may  contain  or  be  free  of  animal  parasites  which  infect  man; 
may  or  may  not  contain  inorganic  salts;  and  may  or  may  not  contain 
pathogenic  bacteria. 

Its  content,  hence  its  purity,  will  vary  with  many  factors,  e.g., 
geologic  formation,  proximity  to  human  habitation,  freezing  and  thaw- 
ing, rainy  or  dry  season,  sewage  output  from  cities,  etc. 

River  water  contains  considerable  matter  in  suspension,  and  in 
clayey  countries,  some  of  this  suspended  matter  is  ultramicroscopic. 

3.  Ground  Water. — Ground  or  subsoil  water  may  be  defined  as  that 
part  of  meteoric  water  which  has  percolated  through  the  superficial 
strata  of  the  earth's  surface  until  it  has  reached  a  clayey  or  other 
impermeable  stratum. 

The  level  of  this  ground  water  will  vary  with  the  thickness  and 
inclination  of  permeable  strata,  barometric  pressure,  and  degree  of 
precipitation. 

Just  as  with  surface  water,  this  water  is  derived  from  meteoric 
water,  and  as  ground  water  percolates  its  depth  will  vary  from  a 
fraction  of  an  inch  to  hundreds  of  feet,  depending  upon  the  above- 
mentioned  conditions. 

Ground  water  is  apt  to  contain  much  less  suspended  matter  than 
surface  water,  as  matter  in  suspension  will  have  been  removed  in  good 
part  by  the  process  of  percolation  through  the  soil — natural  filtration. 

In  exchange  for  its  suspended  matter  this  water  takes  into  solution 
a  part  of  the  soluble  mineral  salts  contained  in  the  ground  through  which 
it  passes. 

Ground  water  may  be  obtained  anywhere  by  digging  to  sufficient 


WATER  85 

depth.  It  is  by  capillarity  that  this  water  keeps  moist  the  superficial 
layers  of  the  soil. 

The  more  water  pumped  from  a  shallow  well,  the  greater  the  dis- 
tance ground  water  must  come  to  replace  the  water  removed,  and  hence 
the  probability  of  pollution  is  increased  in  proportion  to  demands  upon 
the  well. 

Ground  water  is  in  constant  motion  toward  an  outlet  somewhere, 
just  as  is  a  river  (not  rapidly  because  the  movement  is  a  sort  of  percola- 
tion process),  and  like  the  river  its  level  may  rise  and  fall  depending 
upon  the  water  supply. 

Its  rate  of  movement  is  15  to  250  feet  in  twenty-four  hours. 

4.  Deep  Ground  or  Artesian  Water. — Deep  ground  or  artesian 
water  is  that  which  is  found  at  a  very  great  depth,  having  made  its  way 
between  deep  and  impermeable  strata.  The  artesian  well  is  the  result 
of  tapping  this  water  at  great  depth. 

Depending  upon  the  "head"  or  source  of  the  subterranean  water 
will  be  its  level.  At  times  the  difference  of  level  between  the  site  of 
the  well  and  of  the  source  is  great.  If  the  source  be  much  higher  than 
the  well  the  water  may  emerge  from  it  with  such  force  as  to  throw  it 
into  the  air  and  obviate  the  necessity  for  the  employment  of  a  pump. 

Artesian  water  is  free  of  organic  pollution,  and  on  the  other  hand 
contains  soluble  substances  derived  from  the  geological  strata  with 
whirh  the  water  has  come  into  contact. 

Characteristics  of  Water/ — Rain  water  is  apt  to  be  pure,  i.e.,  patho- 
genic germs  are  not  present,  and  unless  near  the  sea  is  apt  to  contain  no 
inorganic  salts.  It  is  "soft." 

Surface,  ground,  and  artesian  waters  are  apt  to  contain  soluble 
substances  from  the  geological  strata  through  or  over  which  they  pass. 
If  \\ater  contains  much  lime  or  magnesia  salts  it  is  spoken  of  as  "hard." 
Thn  is  because  of  the  difficulty  of  washing  with  it,  for  soap  refuses  to 
lather  freely  in  the  presence  of  these  salts,  but  precipitates  instead; 
9.g.j  each  ^rain  CaCO3  in  a  hard  water  must  be  satisfied  with  8  grains 
of  -  >ap  before  lather  will  form. 

There  are  two  kinds  of  hardness  of  water,  temporary  and  permanent. 

Temporary  hardness  is  due  to  bicarbonates  of  calcium  and  magne- 
sium kept  in  solution  by  CO2  contained  in  the  water.  Boiling  drives  off 
the  ('>'_  which  precipitates  the  insoluble  carbonates,  so  that  some  hard 
water  will  be  soft  and  usable  after  boiling  has  removed  its  "temporary 
har-Jness."  The  carbonates  are  deposited  on  the  bottom  of  the  bqjler. 


86  NAVAL   HYGIENE 

If,  however,  the  hardness  is  due  to  the  presence  of  fixed  salts  of 
calcium  and  magnesium,  the  hardness  is  not  removable  by  boiling  and 
is  called  permanent  hardness  in  contradistinction  to  temporary  or 
removable  hardness  which  disappears  upon  boiling. 

Rain  water  and  all  waters  which  do  not  contain  the  salts  of  the 
alkaline  earths  are  called  soft  waters,  lather  freely  and  may  be  used 
with  comfort  if  they  are  otherwise  pure. 

Pollution  of  Water. — Water  may  be  polluted  by  various  contami- 
nants which  may  be: 

1.  Chemical  and  in  solution; 

2.  Mechanical: 

(a)  Organic: 

1.  Animal,  living  or  dead; 

2.  Vegetable,  living  or  dead; 

(b)  Inorganic  and  in  suspension. 

Chemical  pollution  may  be  organic  or  inorganic,  it  may  be  gaseous, 
in  solution  or  in  suspension. 

Chemical  pollution  will  necessarily  vary  with  the  character  of  the 
atmosphere  through  which  the  water  has  fallen;  with  the  character  of 
industries;  with  the  surfaces  upon  which  it  has  fallen;  with  the  geolog- 
ical strata  through  which  it  has  been  percolated;  with  the  place  and 
method  of  storing  it;  with  the  character  of  the  pipes  through  which  it 
may  be  distributed;  and  with  the  character  of  the  containers  in  which 
it  may  be  held  for  temporary  use  within  the  habitations. 

Mechanical  pollution  may  be  either  microscopic  or  macroscopic; 
may  be  living  or  dead  animal  or  vegetable  matter;  or  may  contain 
particles  of  inorganic  matter  in  suspension,  e.g,,  clay,  silicates,  etc. 

Animal  pollution  of  water  may  of  course  vary  from  unicellular  to 
vertebrate  forms,  living  or  dead. 

A  large  number  of  animal  forms  normally  are  found  in  water,  and 
so  far  as  we  know  are  productive  of  no  ill-effect  upon  man.  Some  of 
the  more  highly  organized  animals  are  occasionally  found,  e.g.,  Cyclops 
tenucornis,  Daphnia,  and  some  of  the  nematodes,  as  distomum,  etc. 

Again  the  ova  of  the  parasitic  animals  which  infect  the  human  intes- 
tine are  found. 

Vegetable  contamination  consists  ,of  many  of  the  chlorophyl-bearing 
algae;  diatomacae,  etc.  But  more  important  to  us  are  tht-  non- 
chlorophyl-bearing  plants,  e.g.,  bacteria,  cladothrix,  leptothrix. 

The  presence  of  the  various  forms  of  animal  or  vegetable  life  in 


WATKR  87 

water  indicates  in  general  terms  the  presence  of  food  materials  neces- 
sary to  their  existence,  but  not  necessarily  organic  or  harmful  to  man. 

POTABLE  WATER 

Appearance. — A  pure  water  should  be  clear,  transparent,  limpid, 
colorless  (slightly  bluish  if  viewed  against  a  white  surface  and  in  a  deep 
vessel)  and  sparkling  if  it  contains  much  CO2. 

A  colorless,  beautiful  water  may  contain  harmful  inorganic  sub- 
stances, ova  of  animal  parasites  or  pathogenic  bacteria  in  dangerous 
proportions. 

A  potable  water  may  possess  a  certain  amount  of  turbidity,  more 
pronounced  after  rains,  which  may  settle,  or  be  precipitated  by  chemical 
means. 

Again  a  potable  water  may  have  a  brownish  color  due  to  the 
presence  of  the  compounds  of  iron  or  organic  matter. 

Generally  speaking,  water  takes  its  color  from  vegetable  substances 
\v  th  which  surface  waters  come  in  contact.  Colorlessness  does  not 
indicate  purity. 

Reaction. — Water  containing  CO2  may  be  faintly  acid,  but  most 
drinking  waters  are  alkaline  due  to  the  presence  of  small  amounts  of 
alkaline  carbonates. 

Rain  waters  are  often  slightly  acid  due  to  the  presence  in  the  air 
of  products  of  combustion. 

Mineral  acids  are  found  in  streams  in  mining  districts. 

Odor.— Ordinarily  no  odor  is  detected  upon  examination  of  pure 
water  which  is  fresh. 

Putrefactive  changes  may  be  present  in  water  due  to  action  of 
bacteria  upon  sulphates  giving  odor  of  sulphuretted  hydrogen. 

Certain  animal  and  vegetable  forms  may  be  present  in  potable 
water  and  impart  to  it  a  noticeable  odor,  which  will  be  more  pronounced 
upon  heating. 

£.#.,  the  Boston  water  supply  was  in  1878  found  to  have  a  peculiar 
odor  due  to  the  decomposition  of  fresh  water  sponge  growth. 

Taste. — Pure  water  has  no  taste  except  from  the  gases  which  it  may 
absorb. 

The  various  salts  may  be  present  in  large  proportion  before  they 
may  be  detected  by  taste.  Sodium  chloride  must  be  present  in  excess 
of  60  grains  per  gallon  before  it  can  be  tasted. 


88  NAVAL   HYGIENE 

It  must  be  repeated  that  a  water  may  be  clear,  odorless,  and 
tasteless — yet  very  dangerous. 

Ammonia,  chlorides,  nitrates,  and  nitrites  in  themselves  are  not 
dangerous  to  man,  but  they  are  indices  of  probable  contamination. 

They  perform  the  same  function  in  relation  to  water  that  CC>2  does 
for  air. 

Their  presence  indicates  pollution,  present  or  past,  and  must  be 
regarded  with  suspicion. 

Sources  of  Water. — Man  obtains  water  from  several  sources,  chief 
among  which  are: 

1.  Rain  water  in  cisterns: 

Underground; 
Above  ground; 

2.  Rivers,  lakes,  ponds,  and  springs; 

3.  Wells; 

4.  Artesian  wells; 

5.  Distillation. 

Rain  Water. — In  sections  where  surface  or  ground  waters  are  not 
available  for  water  supply,  rain  water  may  be  caught  and  preserved 
for  use  in  cisterns. 

The  water  is  usually  caught  upon  the  roofs  of  houses  which  are 
provided  with  gutters  and  down  spouts  for  conducting  it. 

The  form  of  the  roof  matters  little  in  estimating  its  water  collecting 
capacity,  for  the  actual  superficial  area  occupied  by  the  house,  and  not 
the  superficial  area  of  the  roof  will  determine  the  amount  of  water 
caught  during  a  given  rainfall. 

A  rainfall  of  i  inch  upon  a  square  yard  gives  5.61  gallons  (gallon  = 
231  cubic  inches). 

A  rainfall  of  i  inch  upon  a  house  20  feet  square,  equals  about  250 
gallons. 

Rain  water  should  be  collected  only  after  rain  has  been  falling  for 
some  time  in  order,  (i)  to  wash  thoroughly  the  roof,  and  (2)  that  the 
lower  air  strata  may  be  washed  of  dust  and  bacterial  content. 

Cisterns  in  which  rain  water  is  preserved  should  be  steened  with 
stone,  brick,  or  concrete,  and  cement  mortar  if  underground,  and 
should  be  water-tight.  In  no  case  should  lead,  copper,  zinc,  iron,  etc., 
be  used  for  lining,  as  the  CO2  in  the  water  attacks  these  metals  in  a 
measure.  Lime  mortar,  too,  is  apt  to  give  salts  of  lime  to  the  water 
which  make  it  hard  and  impart  a  disagreeable  taste. 


WATER  89 

Cisterns  should  be  provided  with  overflow  pipes  which  discharge 
into  the  air — not  into  a  sewer  or  house  drain. 

Cisterns  should  be  carefully  covered  to  prevent  the  entrance  of  dust, 
insects,  and  small  animals. 

All  openings  discharging  into  the  air  should  be  thoroughly  screened 
with  copper  or  bronze  wire,  18  strands  to  the  linear  inch,  to  prevent 
access  of  mosquitoes  and  small  insects. 

Not  infrequently  water  from  roofs  is  passed  through  sand  niters 
before  it  is  permitted  to  enter  the  cistern. 

The  integrity  of  the  cistern  is  of  vital  importance  and  the  cistern 
should  be  frequently  inspected  to  detect  the  presence  of  possible  cracks. 

It  seems  needless  to  say  that  all  the  openings  above  ground  should 
be  of  such  height  and  nature  as  to  prevent  the  inflow  of  uncontrolled 
water. 

In  some  localities  the  cisterns  are  made  of  brick,  stone,  iron,  or 
wood  and  are  above  ground.  While  not  so  liable  to  pollution  by  seep- 
age these  cisterns  are  apt  to  afford  in  summer  a  warmer  water  supply 
than  would  the  underground  cistern. 

Wooden  cisterns  are  undesirable,  especially  in  hot  countries,  as  the 
wood  decays  rapidly  and  requires  constant  repairing. 

Surface  Water. — Rivers,  lakes,  ponds,  and  springs. 

As  a  spring  emerges  from  the  earth  in  an  uninhabited  area  we  are 
apt  to  find  a  very  pure  drinking  water. 

It  is  ground  water  as  it  emerges,  but  immediately  becomes  surface 
water  as  it  flows  away  to  form  perhaps  the  headwaters  of  a  large  river. 

Upon  its  emergence  the  waters  may  be  hard  or  soft,  depending  for 
its  character  upon  the  geological  strata  with  which  it  has  been  in 
contact. 

This  fresh  spring  water  contains  more  inorganic  than  organic  sub- 
stances— the  animal  and  vegetable  life  having  been  in  part  filtered 
from  it  in  the  process  of  percolation. 

As  the  water  flows  upon  the  surface  receiving  accessions  from  other 
>t  reams,  surface  wash  from  rain  water,  and  the  sewage  from  towns  and 
rities  upon  its  bajiks,  it  becomes  more  polluted  as  the  population  grows 
denser. 

In  general  rivers  ate  composed  chiefly  of  rain  water,  or  surface 
wash.  In  its  onward  flow  this  water  receives  a  large  amount  of  low 
animal  and  vegetable  life,  sewage,  drainage,  and  pollution  resulting 
from  the  industries. 


QO  NAVAL   HYGIENE 

In  such  a  water  the  purifying  action  of  the  sun  is  pronounced  and 
is  aided  by  agitation  of  the  water  in  its  rippling  over  a  shallow  rough 
bottom. 

This  action  of  the  sun  has  little  effect  upon  organisms  in  presence 
of  turbidity. 

In  streams  near  large  cities  the  bacterial  action  may  be  very  great  and  in  its 
effort  to  oxidize  the  sewage  pollution  so  much  of  the  oxygen  in  the  water  may  be 
consumed  that  the  water  will  not  support  the  life  of  fish,  e.g.,  the  Thames  at  London 
and  the  Seine  at  Paris. 

The  water  in  surface  streams  is  more  turbid  during  rainy  weather 
than  during  dry  weather,  due  to  the  larger  suspended  content  which  is 
washed  from  the  watersheds. 

Where  large  water  supply  is  obtained  from  rivers  and  streams  it 
usually  becomes  necessary  to  dam  them  and  thus  to  convert  them  into 
large  reservoirs  through  which  all  or  a  part  of  the  river  flows.  It 
becomes  necessary  at  times  to  purchase  large  tracts  of  land  about  these 
reservoirs,  whether  formed  by  dams,  small  lakes,  or  ponds,  in  order 
that  uninhabited  watersheds  may  be  secured. 

Wells. — In  almost  any  locality  one  may  obtain  water  by  boring  to 
sufficient  depth.  Such  an  artificial  opening  of  the  superficial  strata 
of  the  earth  down  to  water  level  is  called  a  well. 

A  well  less  than  50  feet  deep  is  a  "shallow  well"  and  a  well  over 
100  feet  deep  is  called  a  "deep  well." 

The  well  may  be  either  (i)  a  "dug  well,"  or  (2)  a  tubular  or  driven 
well. 

1.  A  dug  well  is  of  large  caliber,  and  frequently  is  imperfectly 
steened.     The  dug  well  has  a  large  mouth  through  which  it  is  quite 
possible  for  contaminants  to  enter,  especially  as  such  wells  are  too 
frequently  drawn  from  by  means  of  a  windlass  and  bucket,  which  latter 
is  subjected  to  constant  handling  by  hands  not  always  clean.     Shallow 
wells  are  far  more  apt  to  be  polluted  on  this  account. 

Wells  are  said  to  drain  a  segment  of  the  earth  the  shape  of  an  in- 
verted cone,  the  base  having  a  diameter  of  four  times  the  depth  of  the 
well.  Water  making  its  way  through  the  ground  in  the  vicinage  of  a 
dug  well,  i.e.,  within  the  supply  area  of  a  dug  well,  tends  constantly 
toward  the  well  because  of  the  diminished  lateral  pressure. 

2.  Tubular  or  driven  wells  are  obtained  by  forcing  a  drill  through 
the  earth  until  a  water-bearing  stratum  is  reached,  and  then  driving 


in  a  galvaniz< 


WATER  91 


ri  a  galvanized  iron  tube  from  the  surface  to  the  bottom,  after  which 
a  pump  is  attached  to  the  tube. 

It  will  be  evident  that  pollution  from  above  through  the  pump 
is  not  apt  to  occur,  and  as  the  sections  of  the  tube,  which  is  about  4 
inches  in  diameter,  are  screwed  into  each  other  as  they  are  driven 
down,  surface  contamination  is  less  probable  than  in  a  dug  well. 

As  driven  wells  are  usually  wells  of  greater  depth  than  the  standard 
set  for  shallow  wells,  it  would  appear  that  the  water  from  driven  wells 
is  probably  pure  unless  perchance  some  subterranean  fissure  exists 
through  which  surface  contamination  could  occur. 

Much  stress  is  laid  upon  the  bacteriological  pollution  of  well  water 
by  seepage  or  percolation  from  cess  pools  through  the  earth  into  the 
v/ell. 

Such  pollution  must  be  less  frequent  than  is  commonly  supposed. 
When  one  considers  the  filtering  power  normal  to  the  earth's  strata, 
the  distance  through  which  fecal  matter  would  have  to  pass  in  most 
cases,  and  the  infrequency  with  which  Bacillus  typhosus  has  been 
isolated  in  well  water,  it  would  seem  that  we  should  look  elsewhere  for 
the  source  of  infection.  The  possibility  of  such  pollution  is  freely 
.idmitted,  but  it  seems  probable  that  only  the  filtered  sewage  would 
reach  the  well,  the  solids  and  bacterial  growth  being  held  back  by 
the  strata  of  earth  unless  fissures  permit  direct  communication 
between  the  well  and  the  cess  pool.  This  may  happen  in  limestone 
formations. 

The  possibility  of  such  direct  communication  should  always  be 
borne  in  mind,  and  the  possibility  of  the  existence  of  an  old  and 
forgotten  pipe  communication,  fissures  in  the  earth,  excavation  for  new 
construction,  or  the  holes  or  burrows  of  moles  or  rats  in  search  of  water 
should  be  remembered. 

Filtration  removes  99^  per  cent,  of  bacteria  from  water;  so,  as 
Mated  above,  it  seems  very  probable  that  bacterial  pollution  of  a  well 
through  the  earth  is  relatively  infrequent. 

Artesian  wells  are  usually  very  deep,  bored  wells,  having  pure  water 
which  is  frequently  under  pressure  so  great  that  it  flows  spontaneously 
from  the  tube  without  pumping.  Although  this  water  is  quite  pure 
it  is  usually  very  hard,  having  absorbed  the  soluble  salts  of  magnesium 
and  calcium,  as  well  as  other  alkaline  salts  from  the  strata  through 
and  along  which  the  water  has  passed,  and  is  generally  poorly  aerated, 
hence  loses  some  of  the  palatability  which  good  water  should  possess. 


g  2  NAVAL  HYGIENE 

Water  Analysis. — The  potability  of  a  given  water  can  be  determined 
only  after  a  careful  analysis  of  the  water  under  standard  bacteriological 
and  chemical  conditions,  and  a  careful  survey  of  source  and  a  considera- 
tion of  possible  pollution. 

Appearance,  odor,  taste,  etc.,  may  tell  much,  but  not  enough.  Of 
prime  importance  is  examination  of  the  source  of  the  water,  as  to  its 
probable  contamination  by  human  excreta,  for  as  a  general  rule  the 
infections  which  affect  man  are  propagated  by  man. 

Bacteriological  analysis  is  of  far  more  importance  than  the  chemi- 
cal. The  value  of  the  latter  should  not  be  underestimated,  but  the 
bacteriological  analysis  demonstrates  the  presence  or  absence  of 
pathogenic  organisms,  and  chemical  analysis  can  only  offer  presump- 
tive evidence  concerning  the  occurrence  of  such  organisms  in  water. 

i.  The  chemical  analysis  of  a  water  is  a  great  aid  in  determining 
the  pollution  of  a  water  supply,  but  the  findings  frequently  vary  so 
much  and  within  a  limit  of  permissible  impurity,  if  the  percentage  of 
the  ingredient  be  alone  considered,  that  the  result  of  such  examination 
should  not  be  regarded  as  evidence  of  purity  or  contamination  unless  a 
comparison  is  made  between  these  results  and  the  findings  in  the  ex- 
amination of  a  pure  water  in  the  same  neighborhood. 

In  the  chemical  examination  the  color,  odor,  turbidity  and  sediment 
should  be  noted,  and  total  solids,  chlorine,  free  ammonia,  albuminoid 
ammonia,  nitrites,  nitrates,  oxygen  consuming  power,  hardness,  and 
presence  of  poisonous  metals  are  determined. 

In  practical  work  the  estimations  of  total  solids,  free  ammonia  and 
albuminoid  ammonia  are,  despite  their  great  value,  not  practical  aboard 
ship,  because  the  necessary  apparatus  is  not  available,  and  the  motion 
of  the  ship  would  interfere  with  the  delicate  manipulation  of  the 
apparatus. 

The  estimation  of  hardness  is  not  of  vital  hygienic  value,  although 
it  is  desirable,  of  industrial  importance,  and  should  be  made. 

Estimation  of  chlorine,  nitrites,  nitrates,  and  oxygen  consuming 
power  constitute  the  practicable  chemical  examination  of  water 
under  average  conditions  aboard  ship. 

Decomposing  animal  matter  is  resolved  into  its  elements.  Of  these 
nitrogen  combining  with  hydrogen  forms  first  ammonia.  Conse- 
quently the  presence  of  "free  ammonia"  indicates  pollution  in  early 
stages  of  reduction,  e.g.,  raw  sewage.  Later  as  the  water  percolates 
through  the  soil  it  takes  up  oxygen  and  gradually  becomes  nitrous 


WATER  93 


acid  and  nitric  acid — the  final  stage.  Nitrites  are  evidence  then  of 
the  intermediate  stage  of  reduction  and  nitrates  indicate  the  final 
Nitrites  and  nitrates  plus  chlorine  strongly  indicate  sewage 
contamination. 

Decomposing  vegetable  matter  yields  very  little  nitrogen;  plants 
utilize  nitrites  and  nitrates  as  food;  hence  water  polluted  by  decom- 
posing vegetable  matter  shows  a  very  small  content  of  nitrites  and 
nitrates,  or  none  at  all.  In  other  words,  increase  of  chlorine,  nitrous 
acid  (as  nitrites),  and  nitric  acid  (as  nitrates)  indicates  pollution  from 
animal  sources  most  frequently,  but  not  always. 

Skill  in  laboratory  methods  and  a  knowledge  acquired  from  study 
of  analyses  of  specimens  of  water  are  necessary  for  the  correct  inter- 
pretation of  results  in  a  given  case. 

Bacteriological  Analysis.  —  The  bacteriological  analysis  of  water 
demonstrates  the  presence  or  absence  of  pathogenic  organisms  in  the 
specimen  examined,  and  affords  more  than  the  presumptive  evidence 
offered  by  the  chemical  examination. 

The  presence  of  B.  coli,  or  of  other  intestinal  organisms  indicates 
sewage  pollution. 

Increase  of  chlorides,  nitrites  and  nitrates  may  indicate  sewage 
j  ollution.  It  may  not. 

The  following  instructions  for  the  chemical  and  bacteriological 
examination  of  water  are  quoted  from  the  official  "Memoranda  to 
Accompany  the  Naval  Test  Case  and  Microscopical  Outfit,"  supplied 
to  the  Medical  Department,  U.  S.  Navy: 

BACTERIOLOGICAL  ANALYSIS 

1.  The  three  principal  points  to  consider  are: 

(a)  Number  of  bacteria  per  cubic  centimeter. 

(b)  Nature  of  bacteria  (whether  developing  at  37.5°C.). 

(c)  As  to  presence  of  special  organisms  (B.  coli,  B.  typhosus,  streptococci,  Sp. 
cholera  asiatic.(c). 

2.  In  collecting  water  attend  to  the  following  points: 

(a)  Bottles  (from  25  to  100  c.c.  capacity)  should  be  sterilized  (either  by  heat 
<  r  by   rinsing   with  a  little  HjSO*  and  subsequently  washing  thoroughly  with  the 
suspected  water  before  collecting).     If  to   be  transferred,  pack  in  ice  to  prevent 
bacteriological  development.     (Frankland  states  that  a  count  of  1000  per  cubic 
centimeter  became  6000  in  six  hours  and  48,000  in  forty-eight  hours.) 

(b)  If  collecting  from  city  water  supply  be  sure  not  to  take  from  a  cistern,  but 
always  direct  from  mains.     Let  the  water  from  tap  run  a  few  minutes  before   collect- 


94  NAVAL  HYGIENE 

ing.  If  from  pond,  stream,  or  cistern,  be  sure  that  the  water  comes  from  at  least 
12  inches  below  surface  (avoidance  of  surface  scum,  etc.). 

(c)  In  relatively  pure  waters,  as  from  springs,  bacteria  multiply  rapidly  during 
first  few  days;  in  impure  water,  however,  multiplication  is  slow. 

Quantitative  Bacteriological  Examination. — (A)  Deliver  definite  quantities  of 
the  water  to  be  examined  into  tubes  of  liquefied  gelatin  or  agar  and  plate  out  the 
same  in  a  series  of  Petri  dishes. 

A  more  practical  method  is  to  deliver  the  water  from  the  graduated  pipette  into 
the  empty  sterile  dish.  The  water  should  be  deposited  in  the  center  of  the  plate 
and  the  melted  gelatin  or  agar  poured  directly  on  the  water  and  then  carefully 
tilted  to  and  fro  to  mix  the  water  and  the  medium.  One  set  of  plates  should  be 
of  gelatin  and  incubated  at  room  temperature;  a  similar  set  should  be  of  lactose 
litmus  agar  and  incubated  at  38°C.  If  the  water  is  highly  contaminated  it  is  neces- 
sary to  dilute  it;  thus,  with  river  water,  which  may  contain  from  2000  to  10,000 
bacteria  per  cubic  centimeter,  a  dilution  of  i  to  100  would  be  desirable. 

Ordinarily  it  will  be  sufficient  to  deliver  from  a  sterile  graduated  pipette  0.2, 
0.3,  and  0.5  c.c.  of  the  water  in  each  of  two  sets  of  plates,  one  set  for  gelatin,  the 
other  for  agar. 

When  gelatin  is  not  at  hand  or  convenient  to  work  with,  the  gelatin  plates  may 
be  replaced  by  others  of  lactose  litmus  agar  for  incubation  at  room  temperature. 
After  twenty-four  hours  at  38°C.  or  forty-eight  hours  at  2o°C.  the  count  should 
be  made. 

Example. — Forty  colonies  were  counted  on  the  gelatin  plate  containing  0.2 
c.c.  (Y$)  of  the  water.  The  number  of  organisms  would  be  200  per  cubic  cen- 
timeter. Ten  colonies  were  counted  on  the  agar  plate  containing  0.2  c.c.  and 
incubated  at  38°C.  Number  of  bacteria  developing  at  body  temperature  equals 
50  per  cubic  centimeter. 

There  is  no  strict  standard  as  to  the  number  of  bacteria  a  water  should  contain 
per  cubic  centimeter.  Koch's  standard  of  100  colonies  per  cubic  centimeter  is 
generally  given.  It  is  by  the  qualitative  rather  than  the  quantitative  analysis 
that  one  should  judge  a  water. 

If  there  should  be  very  many  colonies  on  a  plate  the  surface  can  be  marked  off 
into  segments  with  a  blue  pencil.  If  very  numerous,  cut  out  of  a  piece  of  paper  a 
space  equal  to  i  square  centimeter.  By  counting  the  number  of  colonies  inclosed 
in  this  space  at  different  parts  of  the  plate  we  can  strike  an  average  for  each  space  of 
i  square  centimeter.  To  find  the  number  of  such  spaces  contained  in  the  plate, 
multiply  the  square  of  the  radius  of  the  plate  by  3.1416;  then  multiply  this  number 
by  the  average  per  square  centimeter  and  we  have  the  total  number  of  colonies  on 
the  plate.  This  is  the  principle  of  the  Jeffers  disk. 

The  relative  proportion  between  the  bacterial  count  at  2o°C.  and  that  at  38°C. 
is  of  great  importance  from  a  qualitative  standpoint,  as  will  be  seen  later. 

(B)  Deliver  into  a  series  of  Durham  fermentation  tubes  containing  glucose 
bouillon,  and  into  another  series  containing  lactose  bouillon,  varying  definite 
amounts  of  the  water  to  be  examined.  In  specimens  showing  the  presence  of  gas 
in  both  glucose  and  lactose  bouillon  the  evidence  is  presumptive  that  the  colon 
bacillus  is  present.  For  the  positive  demonstration  plates  must  be  made  from  such 
tubes  as  show  gas. 


WATER  95 


It  is  sufficient  to  deliver  from  graduated  pipettes  in  each  series  quantities  of  water 
varying  in  amount  from  o.i  c.c.  to  10  c.c.  In  our  laboratory  we  inoculate  with  o.i 
c.c.,  0.2  c.c.,  0.5  c.c.,  i  c.c.,  and  10  c.c.  of  the  suspected  water.  If  the  o.i  c.c. 
tubes  show  gas  we  have  reason  to  assume  that  the  water  contained  at  least  10  colon 
bacilli  per  cubic  centimeter.  If  only  the  10  c.c.  tubes  showed  gas — those  with  less 
amounts  not  having  gas — we  would  be  in  a  position  to  state  that  the  water  contained 
the  colon  bacillus  in  quantities  of  10  c.c.,  but  not  in  quantities  of  i  c.c.  or  less. 
Many  authorities  regard  water  as  suspicious  only  when  the  colon  bacillus  is  present 
in  quantities  of  10  c.c.  or  less,  waters  of  good  quality  frequently  showing  the  presence 
of  the  colon  bacillus  in  quantities  of  100  to  500  c.c. 

It  is  generally  accepted  that  if  a  water  shows  the  presence  of  the  colon  bacillus 
in  quantities  of  i  c.c.  or  less  it  should  be  regarded  as  suspicious. 

At  the  present  time  the  medium  that  gives  the  least  source  of  error  in  carrying 
out  the  quantitative  presumptive  tests  is  the  lactose  bile.  It  is  made  by  adding 
i  per  cent,  of  lactose  and  i  per  cent,  of  peptone  to  ox  bile,  and  fermentation  tubes  of 
the  media  showing  gas  may  be  considered  as  very,  probably  containing  the  colon 
bc.cillus.  The  percentage  of  error  with  this  method  is  reported  to  be  only  n  per 
cent.,  while  with  glucose  fermentation  tubes  the  error  is  more  than  50  per  cent. 
Gas  formation  is  usually  shown  in  forty-eight  hours,  but  it  is  advisable  to  continue 
the  incubation  for  seventy-two  hours.  These  presumptive  tests  are  chiefly  of 
vi.lue  in  highly  contaminated  waters.  Even  with  this  method  plates  should  be 
made. 

(c)  As  the  colon  and  sewage  streptococci  ferment  lactose  with  the  production  of 
acid  and  hence  produce  pink  colonies  on  lactose  litmus  agar,  much  information 
can  be  obtained  from  the  proportion  existing  between  the  number  of  pink  colonies 
and  those  not  having  such  a  color.  Waters  of  fair  degree  of  purity  rarely  give  any 
pink  colon 

Qualitative  Bacteriological  Examination. — General  Considerations. — In  some 
countries  the  proportion  of  liquefying  to  non-liquefying  colonies  on  gelatin  plates  is 
considered  of  importance.  Certain  sewage  organisms  belonging  to  the  proteus  and 
cloaca  group  liquefy  gelatin;  consequently,  if  the  proportion  of  liquefying  to  non- 
liquefying  be  greater  than  as  i  to  10,  the  water  is  considered  suspicious.  The  test 
is  not  considered  by  American  authorities  as  of  any  particular  value. 

The  American  Public  Health  Association  recognizes  the  importance  of  the  in- 
formation obtained  from  a  comparison  of  the  number  of  organisms  developing  at 
38°C.  and  those  developing  at  2o°C.  Bacteria  whose  normal  habitat  is  the  intestinal 
canal  naturally  develop  well  at  body  temperature,  while  normal  water  bacteria 
prefer  the  average  temperature  of  the  water  in  rivers  and  lakes.  Consequently 
\\  u-n  the  number  of  organisms  developing  at  38°C.  at  all  approximates  the  number 
developing  at  2o°C.,  there  is  a  strong  suspicion  that  sewage  organisms  may  be 
present.  Normal  waters  give  proportions  of  i  to  25  or  i  to  50,  while  in  sewage- 
o  ntaminated  waters  the  proportion  may  be  as  i  to  4  or  less. 

In  addition,  the  appearance  of  pink  colonies  on  the  lactose  litmus  agar  is  of  great 
assistance  in  judging  a  water.  Both  sewage  streptococci  and  the  colon  bacillus 
give  pink  colonies — those  of  the  streptococci  are  smaller  and  more  vermilion  in 
color.  Microscopic  examination  will  differentiate  the  cocci  from  the  bacilli.  It  is 
well  to  bear  in  mind  that  the  pink  colonies  after  twenty-four  hours  may  turn  blue 


96  NAVAL  HYGIENE 

(in  forty-eight  hours)  from  the  development  of  ammonia  and  amines.  Consequently 
the  lactose  litmus  agar  plates  should  be  studied  after  twenty-four  hours. 

A  good  water  supply  will  rarely  show  a  pink  colony,  while  in  a  sewage-con- 
taminated one  the  pink  colonies  will  probably  predominate. 

The  diagnostic  characteristics  considered  important  by  the  American  authorities 
in  reporting  the  colon  bacillus  (recently  designated  as  excretal  colon  bacillus)  are: 

(a)  Typical  morphology,  nonsporing  bacillus,  relatively  small  and  often  quite 
thick. 

(b)  Motility  in  young  broth  cultures.     (This  is  at  times  unsatisfactory,  as  some 
strains  of  the  colon  bacillus  do  not  show  it  even  in  young  bouillon  cultures.) 

(c)  Gas  formula  in  dextrose  broth.     Of  about  50  per  cent,  of  gas  produced,  one- 
third  should  be  absorbed  by  a  2  per  cent,  solution  of  sodium  hydrate  (€02),  the 
remaining  gas  being  hydrogen.    Later  views  indicate  that  the  gas  formula  is  ex- 
ceedingly variable  and  should  not  be  depended  upon.     To  carry  out  this  test  one 
fills  the  bulb  of  a  fermentation  tube  with  the  caustic-soda  solution,  holding  the  thumb 
over  the  opening  or  closing  it  with  a  rubber  stopper;  the  bouillon  culture  and  the 
soda  solution  are  mixed  by  tilting  the  fermentation  tube  to  and  fro.     The  total 
amount  of  gas  is  first  recorded  and  then  that  remaining  after  the  CO2  has  been  ab- 
sorbed is  reported  as  hydrogen. 

(d)  Nonliquef action  of  gelatin. 

(e)  Fermentation  of  lactose  with  gas  production. 
(/)  Indol  production. 

(g)  Reduction  of  nitrates  to  nitrites. 

To  these  may  be  added  the  acidifying  and  coagulation  of  litmus  milk  without 
subsequent  digestion  of  the  casein.  The  production  of  gas  and  fluorescence  in 
glucose  neutral  red  bouillon  is  also  a  very  constant  function  of  the  colon  bacillus. 
B.  lactis  aerogenes  is  similar  to  B.  coli,  with  the  exception  of  nonmotility  and  produc- 
tion of  gas  in  saccharose  media.  B.  lactis  ancero  genes  is  also  similar  to  B.  coli, 
but  does  not  produce  gas  in  glucose  and  lactose. 

The  reduction  of  neutral  red  with  a  greenish-yellow  fluorescence  is  very  striking 
and  has  been  suggested  as  a  test  for  the  colon  bacillus.  Many  other  organisms, 
especially  those  of  the  hog  cholera  group,  have  this  power.  It  is  convenient,  how- 
ever, to  color  glucose  bouillon  with  about  i  per  cent,  of  a  ^  per  cent,  solution  of 
neutral  red. 

On  the  plates  made  for  the  detection  of  colon  bacillus  may  be  found  certain 
organisms  which  have  origin  in  fecal  contamination.  The  more  important  of  these 
are  those  of  the  paratyphoid,  cloaca,  and  proteus  groups.  In  addition,  the  B. 
fecalis  alkaligines  has  not  rarely  been  isolated.  Among  natural  water  bacteria  there 
may  be  present  either  the  liquefying  or  the  nonliquefying  B.  fluorescens.  These 
colonies  have  a  yellowish-green  fluorescence. 

Certain  chromogenic  cocci  and  bacilli  are  found  in  uncontaminated  waters  as 
B.  indicus  or  B.  violaceus.  From  surface  washings  we  obtain  certain  soil  bacteria,  as 
B.  mycoides,  B.  subtilis,  B.  megatherium.  One  of  the  higher  bacteria  which  shows 
long  threads,  Cladothrix  dichotoma,  is  common,  and  is  characterized  by  a  brown 
halo  around  its  gelatin  plate  colony. 

Isolation  of  the  Typhoid  Bacillus  from  Water. — This  is  probably  the  most  dis- 
couraging procedure  which  can  be  taken  up  in  a  laboratory.  Only  the  most  recent 


reports  of  such  isolation  from  water  supplies,  which  have  been  verified  by  immunity 
reactions,  t  an  In-  accepted,  and  of  these  the-  number  of  instances  is  exceedingly  small. 
Owing  to  the  long  period  of  incubation,  the  typhoid  organisms  may  have  died  out 
before  the  outbreak  of  an  epidemic  suggests  the  examination  of  the  water  supply. 

There  have  been  various  methods  proposed  for  the  detection  of  the  B.  typhosus 
in  water.  A  method  which  would  offer  about  as  reasonable  a  chance  of  success  as 
any  other  would  be  to  pass  2  or  3  liters  of  the  water  through  a  Berkefeld  filter;  then 
t3  take  up  in  a  small  quantity  of  water  all  the  bacteria  held  back  by  the  filter. 
Then  plate  out  on  lactose  litmus  agar  and  examine  colonies  which  do  not  show  any 
pink  coloration.  The  dysentery  bacillus  has  about  the  same  cultural  characteristics 
as  the  typhoid  one,  so  that  it  is  important  to  note  motility.  If  from  such  a  colony 
you  obtain  an  organism  giving  the  cultural  characteristics  of  B.  typhosus,  carry  out 
agglutination  a»d  preferably  bacteriolytic  tests  as  well.  Some  strains  of  typhoid, 
especially  when  recently  isolated  from  the  body,  do  not  show  agglutination. 

The  Conradi-Drigalski,  the  malachite-green,  and  various  caffeine  containing 
plating  media  have  been  highly  recommended. 

Isolation  of  the  Cholera  Spirillum  from  Water. — The  method  proposed  by  Koch 
in  1893  does  not  seem  to  have  been  improved  upon  by  later  investigators.  To  100 
c.c.  of  the  suspected  water  add  i  per  cent,  of  peptone  and  i  per  cent,  of  salt.  Incu- 
bate at  38°C.,  and  at  intervals  of  eight,  twelve,  and  eighteen  hours  examine  micro- 
scopically loopfuls  taken  from  the  surface  of  the  liquid  in  the  flask.  So  soon  as 
comma-shape  organisms  are  observed,  plate  out  on  agar.  The  colonies  showing 
morphologically  characteristic  organisms  should  be  tested  as  to  agglutination  and 
bacteriolysis.  Inasmuch  as  the  true  cholera  spirillum  shows  a  marked  cholera-red 
reaction  it  is  well  to  inoculate  a  tube  of  peptone  solution  from  such  a  colony 
and  add  a  drop  of  concentrated  sulphuric  acid  after  incubating  for  eighteen  hours. 
The  rose-pink  coloration  is  given  by  the  cholera  spirillum  with  the  acid  alone — the 
nitron  factor  in  the  reaction  being  produced  by  the  organism. 


CHEMICAL  K\  \MI\ATION  OF  WATER 

The  examination  of  water  to  determine  the  probability  of  pollution  and  fitness 
for  domestic  purposes  includes  the  estimation  of  total  solids,  free  and  albuminoid 
ammonia,  nitrogen  as  nitrite  and  nitrate,  chlorine,  oxygen-consuming  power,  and 
hardness.  While  the  foregoing  are  the  necessary  factors  for  the  object  in  view,  the 
following  physical  rharacteristirs  are  also  usually  noted:  Color,  odor,  turbidity,  and 
comparative  quantity  of  sediment.  In  addition  to  these  the  degree  of  alkalinity, 
although  having  no  bearing  on  purity,  is  often  of  service,  and  a  method  for  its  deter- 
mination will  he  included. 

The  quantities  of  the  various  ingredients  present  are  now  very  generally  expressed 
in  parts  per  million  or  the  number  of  grams  of  the  ingredients  contained  in  1,000,000 
grams  of  the  water.  t"nle>s  the  water  is  highly  mineralized  results  of  sufficient 
accuracy  are  obtained  if  1000  c.c.  of  the  water  are  considered  as  1000  grams.  Parts 
per  million  can  be  converted  into  grains  per  United  States  gallon  by  multiplying  by 
0.0584. 
7 


98  NAVAL   HYGIENE 

Color. — Color  is  determined  by  Ming  with  the  sample  a  tube  2  feet  long  and 
capable  of  being  closed  at  both  ends  by  a  glass  plate  and  then  looking  through  the 
long  axis  at  a  white  surface.  Although  attempts  to  fix  standards  have  been  made  it 
is  sufficient  to  note,  in  general  terms,  the  color  observed.  Color  has  no  bearing  what- 
ever on  purity. 

Odor. — Odor  is  determined  by  half  filling  a  flask  with  the  sample  and  bringing  it 
to  boiling,  the  odor  being  noted. 

Turbidity. — Turbidity  is  determined  by  comparing  a  column  of  sample  with 
equal  column  of  distilled  water  containing  known  quantities  of  finely  divided  silica. 
The  results  can  be  expressed  in  parts  per  1,000,000.  This  characteristic  has  to  do 
almost  entirely  with  efficiency  of  clarification  processes. 

Sediment. — Sediment  can  originally  be  present  or  can  form  during  storage.  It 
can  be  either  organic  or  inorganic.  Its  character  rather  than  its  quantity  and  whether 
originally  present  or  developed  during  storage  should  be  determined.  When  col- 
lected and  dried  and  placed  upon  a  piece  of  platinum  foil  or  in  a  porcelain  capsule  it 
will  burn  freely  and  leave  but  little  residue  if  organic;  if  inorganic  it  will  change 
color  and  volume,  but  its  weight  will  not  be  affected  to  so  great  an  extent.  Ferric 
hydrate  separates  from  many  waters.  It  can  be  identified  by  collecting  on  a  filter, 
dissolving  in  dilute  HC1  and  then  adding  a  little  of  a  solution  of  potassium  ferro- 
cyanide,  which  will  produce  a  deep  blue  color  if  iron  is  present.  To  identify  the  na- 
ture of  sediments  generally  requires  application  of  principles  of  qualitative  analysis. 

For  the  following  processes  the  sample  must  not  be  filtered  unless  so  directed,  and 
must  be  well  mixed  before  withdrawing  a  portion  for  a  determination. 

Total  Solids. — Total  solids  consist  of  all  solids  dissolved  and  suspended  in  the 
water.  To  determine  the  quantity  place  200  c.c.  of  the  sample  in  a  porcelain  or 
platinum  dish  of  known  weight,  evaporate  to  dryness,  best  on  a  water  bath,  dry  the 
residue  at  i2o°C.,  cool,  weigh.  The  increase  in  weight  of  dish  represents  the  total 
solids  in  200  c.c.  of  sample.  The  results  should  be  expressed  in  parts  per  1,000,000. 
The  dish  used  should  be  small  and  the  water  added  to  it  in  successive  small  portions 
as  the  evaporation  proceeds  until  all  of  the  200  c.c.  have  been  added. 

Free  Ammonia. — Free  ammonia  consists  of  the  NH3  existing  as  such  together 
with  that  which  is  present  in  the  ammonium  salts.  It  results  from  natural  oxidation 
of  organic  nitrogenous  matter,  but  can  be  derived  by  reduction  of  nitrates  and 
nitrites,  or  it  can  be  an  accidental  addition. 

The  solutions  necessary  for  the  estimation  of  the  ammonias  are: 

Ammonia-free  Water. — Add  sodium  carbonate  to  water  to  the  extent  of  i  gram  to 
the  liter,  place  in  a  still  and  boil,  and  when  distillate  ceases  to  give  reaction  with  Ness- 
ier's  reagent  collect  remainder  of  it  in  a  clean  glass-stoppered  bottle.  Several  liters 
of  this  will  be  required. 

Sodium  Carbonate. — Dissolve  about  40  grams  of  dry  sodium  carbonate  in  250  c.c. 
of  distilled  water. 

Alkaline  Potassium  Permanganate. — Dissolve  200  grams  of  solid  potassium 
hydrate  and  8  grams  of  potassium  permanganate  in  about  1400  c.c.  of  water.  When 
solution  is  complete  evaporate  until  volume  measures  about  1000  c.c.  Keep  in  gla.ss- 
stoppered  bottle. 

Nessler's  Reagent. — Take  two  portions  of  distilled  water  of  about  400  c.c.  each. 
In  one  dissolve  13  grams  of  mercuric  chloride  and  in  the  other  35  grams  of  potassium 


WATER  99 

iodide;  when  solution  is  complete  add  with  constant  stirring  the  mercuric  chloride 
to  the  potassium  iodide  until  a  small  quantity  of  the  red  precipitate  which  forms 
remains  undissolved.  Heat  this  mixture  nearly  to  the  boiling  point  and  allow  to 
stand  from  twelve  to  twenty-four  hours.  Then  add  160  grams  of  solid  potassium 
hydrate  (or  120  grams  solid  sodium  hydrate)  and  stir  until  dissolved.  Now  add 
enough  mercuric  chloride  solution  to  produce  again  a  fairly  abundant  permanent  pre- 
cipitate and  enough  water  to  make  approximately  1000  c.c.  of  solution.  Allow  to 
set  tie  and  then  use  only  the  clear,  slightly  yellowish  supernatant  fluid. 

This  reagent  is  an  alkaline  solution  of  potassium  mercuric  iodide,  HgI2.2KI. 
With  very  small  quantities  of  ammonium  it  produces  a  yellowish  brown  color,  and 
with  larger  quantities  precipitates  are  formed.  It  improves  with  age. 

Standard  Ammonia. — Dissolve  0.315  gram  of  pure  ammonium  chloride  in  100 
c.c.  ammonia  fiee  distilled  water,  then  dilute  i  c.c.  of  this  solution  to  100  c.c.  with 
th.>  ammonia  free  water.  Then  each  cubic  centimeter  of  the  latter  solution,  which 
is  he  standard,  will  contain  o.ooooi  gram  NHs. 

In  a  retort  of  about  1200  c.c.  capacity  place  about  300  c.c.  of  ammonia  free  water 
and  10  c.c.  of  the  sodium  carbonate  solution;  heat  a  small  piece  of  pumice  and  while 
still  red  hot  drop  into  the  solution  in  the  retort.  The  retort  is  then  connected  with  a 
co-idenser  and  heat  applied  and  distillate  is  collected  in  50  c.c.  Nessler  jars  until  a 
portion  is  obtained  which  does  not  give  a  reaction  when  2  c.c.  of  Nessler's  solution  is 
added  to  it.  What  has  been  done  so  far  is  merely  to  free  the  distilling  apparatus  of 
all  ammonia.  The  distillates  so  far  collected  are  now  thrown  away.  Now,  without 
disturbing  its  contents,  add  to  the  retort  500  c.c.  of  the  sample  under  examination. 
Make  connections  tight  and  carry  on  distillation,  catching  distillate  in  50  c.c.  Ness- 
lei  jars  which  have  previously  been  thoroughly  washed  and  then  finally  rinsed  with 
a  little  ammonia  free  water.  As  each  50  c.c.  portion  is  collected  2  c.c.  of  the  Nessler 
reagent  are  added  to  it,  the  tip  of  the  pipette  containing  the  reagent  being  held  some 
distance  above  the  surface  of  the  distillate  to  insure  complete  diffusion  and  mixing, 
which  would  not  occur  if  the  reagent,  because  of  its  density,  were  gently  added. 

A  set  of  standards  is  now  prepared  by  adding  to  a  series  of  50  c.c.  Nessler  jars, 
cleaned  as  directed  above,  0.5,  i.o,  1.5,  2.0,  etc.,  c.c.  of  the  standard  ammonia  solu- 
tion, adding  to  each  jar  sufficient  ammonia  free  water  to  make  50  c.c.  and  then  to 
each  jar  add  2  c.c.  of  Nessler's  reagent  as  directed.  Allow  to  stand  about  ten  min- 
utr-.  Thi>  uives  a  set  of  standards  that  contain,  respectively,  0.000005,  o.ooooi, 
0.000015,  0.00002,  etc.,  gram  of  ammonia.  Now  compare  the  color  of  each  portion 
of  distillate  with  the  standards,  the  observation  being  made  through  the  long  axis  of 
the  tube,  and  note  the  quantity  of  ammonia  in  the  standards  that  match  the  dis- 
tillates in  color.  It  is  obvious  that  the  portions  of  distillate  contain  the  same  quan- 
tity of  ammonia  as  the  standards  of  same  color.  Then  the  sum  of  these  quantities 
will  be  the  weight  of  ammonia  in  500  c.c.  of  sample.  From  this  the  calculation  of 
p;irts  per  1,000,000  is  made. 

.mplc.  —The  fourth  50  c.c.  of  distillate  showed  only  a  very  slight  reaction  with 
the  Ne»ler  reayent.  The  lir>t  50  c.c.  portion  when  compared  with  the  standards  was 
found  to  have  the  same  color  as  the  standard  containing  0.00002  grams  NTH3,  the 
second  portion  of  distillate  the  same  color  as  the  standard  containing  o.ooooi,  and 
the  third  portion  matching  that  containing  0.000005,  then: 


100  NAVAL    HYGIENE 

O.O0002 
O.OOOOI 

o . 000005 
trace 


0.000035  equals  quantity,  in  grams,  free  NH3  in  500  c.c.  of  sample. 


0.000070  equals  quantity,  in  grams,  free  NH3  in  1000  c.c.  of  sample. 

then  0.00007  X  1000  equals  0.07  free  ammonia  expressed  in  parts  per  1,000,000. 

The  sodium  carbonate  solution  is  placed  in  the  retort  to  liberate  NH3  from 
ammonia  salts.  The  reaction  occurring  between  the  Nessler  reagent  and  ammonia 
is: 

2(HgI2.2KI)  +  NH3  +  3KOH  =  NHg2IH2O  +  7KI  +  2H2O, 

the  body  giving  rise  to  the  color  being  hydrated  dimercuriammonium  iodide. 

It  frequently  happens  that  upon  the  addition  of  the  Nessler  solution  a  greenish 
color  instead  of  a  yellowish  brown  develops,  thus  rendering  it  impossible  to  compare 
the  distillates  with  the  standards.  In  such  a  case  continue  the  distillation  until  a 
reaction  with  Nessler  ceases  to  be  given,  then  determine  the  albuminoid  ammonia  as 
directed  below.  After  that  determine  the  total  ammonia  by  taking  a  fresh  500  c.c. 
of  sample,  immediately  adding  50  c.c.  of  alkaline  permanganate  and  distilling  and 
estimating  the  ammonia  in  the  usual  way.  The  difference  between  total  and  albu- 
minoid will  be  the  free  ammonia. 

It  is  important  to  note  that  the  Nessler  reagent  must  under  no  circumstances  be 
placed  in  the  jar  before  distillate  or  standard;  it  must  always  be  the  last  added. 

The  heat  under  the  retort  should  be  so  adjusted  that  fifteen  minutes  will  be 
required  to  collect  50  c.c.  of  distillate.  If  a  more  rapid  rate  of  distillation  than  this 
is  carried  on,  very  low  results  are  likely  to  follow. 

Albuminoid  Ammonia. — This  ammonia  is  derived  through  the  oxidation  of  the 
contained  nitrogenous  organic  matter  by  the  permanganate  and  is  in  a  comparative 
way  the  measure  of  such  organic  matter. 

Without  disturbing  the  contents  left  in  the  retort  from  the  estimation  of  free 
ammonia,  add  50  c.c.  of  the  alkaline  permanganate  solution  and  continue  the  dis- 
tillation, collecting  and  Nesslerizing  the  distillate  as  in  the  determination  of  free 
ammonia,  the  calculation  of  quantity  being  made  in  the  same  way. 

Nitrogen  as  Nitrite. — Of  the  several  methods  for  detecting  and  estimating  the 
nitrite  nitrogen  that  of  Greiss  seems  the  best. 

The  following  solutions  will  be  required.  It  is  essential  that  all  water  used  in 
their  preparation  should  be  free  from  nitrite.  The  use  of  distilled  water  i?  not 
essential. 

Sulphanilic  Acid. — Dissolve  0.350  gram  of  sulphanilic  acid  (C6H4  (NH2)HSO3)  in 
100  c.c.  of  3  per  cent,  acetic  acid. 

N aphthylamine  Hydrochloride  Solution. — Boil  0.05  gram  of  naphthylamine  hydro- 
chloride  (Ci0H7NH2)  in  10  c.c.  of  water,  quickly  strain  through  a  small  plug  of 
cotton,  and  mix  the  filtrate  with  90  c.c.  of  3  per  cent,  acetic  acid. 


WATKK  I 01 


Standard  Sodium  Xitritc.—  Since  sodium  nitrii'j  i-nu'.-ly  part-  this  solution  is  best 
indirectly  prepared.  To  a  strong  solution  of  silver  nitrite  add  a  strong  solution  of 
s<  dium  nitrite,  heat  until  precipitate  formed  is  redissolved,  quickly  filter  and  allow 
filtrate  to  cool;  the  crystals  which  separate  are  filtered  off  and  dissolved  in  a  small 
quantity  of  hot  water.  The  solution  is  allowed  to  cool  and  filtered  and  the  crystals  of 
silver  nitrite  now  on  the  filter  are  dried.  Weigh  out  0.275  gram  of  the  silver  nitrite, 
dissolve  in  a  little  hot  water  and  add  to  it  about  0.2  gram  of  sodium  chloride  and  then 
water  enough  to  make  250  c.c.;  mix  and  allow  to  stand  in  the  dark  until  clear. 
Dilute  10  c.c.  of  clear  solution  to  looc.c.  with  water;  each  cubic  centimeter  of  the 
latter  solution  of  sodium  nitrite  will  contain  o.ooooi  gram  nitrogen  as  nitrite.  To 
50  c.c.  of  the  water  under  examination,  contained  in  a  Nessler  jar  add  2  c.c.  each 
o  sulphanilic  acid  and  naphthylamine  solutions,  using  separate  pipettes  for  meas- 
uring, and  mix  by  means  of  a  glass  rod.  At  the  same  time  dilute  i  c.c.  of  the 
standard  sodium  nitrite  solution  with  45  c.c.  of  water  and  then  add  2  c.c.  each 
of  the  reagent s  as  before.  After  a  lapse  of  half  an  hour  these  solutions  are  exam- 
ined, observations  being  made  through  the  long  axis  of  the  tube.  If  the  water 
has  remained  colorless,  nitrites  are  absent.  If  it  has  become  pink  or  red,  nitrites 
are  present.  To  determine  the  quantity,  compare  the  color  with  that  produced  in 
the  tube  containing  the  i  c.c.  of  standard  nitrite.  If  the  color  is  darker  than  the 
siandard,  which  will  not  often  be  the  case,  repeat  the  whole  experiment — that  is, 
with  both  standard  and  water — but  instead  of  50  c.c.  use  a  smaller  but  known 
quantity  of  water  diluted  to  50  c.c.  Then  into  a  third  Nessler  jar  pour  from 
t  ie  tube  containing  the  i  c.c.  of  standard  just  sufficient  of  the  mixture  to  match 
the  color  produced  in  the  sample  and  note  the  volume  required;  this  volume 
v  hen  multiplied  by  0.0000002  (for  each  cubic  centimeter  of  solution  in  the  tube 
containing  tne  l  c-c-  °f  standard  contains  this  quantity  of  N  as  nitrite)  will  give 
the  quantity  of  \  as  nitrite  in  the  quantity  of  water  tested.  The  parts  per 
i  ,000,000  can  be  readily  calculated  from  this. 

Example. — The  color  produced  in  50  c.c.  of  water  was  exactly  matched  by  15  c.c. 
<  f  the  solution  from  the  tube  containing  the  standard.  Then  15  X  0.0000002  equals 
0.000003,  whirh  is  the  quantity  of  nitrite  in  50  c.c.  of  water.  In  1000  c.c.  of  water 
there  would  be  0.000003  X  20  equals  0.00006  and  this  multiplied  by  1000  gives  0.06. 
The  nitrogen  as  nitrite  is  therefore  0.06  parts  per  1,000,000. 

The  red  color  formed  in  the  test  is  naphthylamineazobenzenesulphonic  acid 
(C,H,  HSO  \  C  II  \IT,). 

The  complete  reaction  is: 

(II     \  II2)HS03  +  HXO2  +  C10H7NH2  =  C6H4(HSO3)N2C,oH6NH2  +  2H2O. 

The  source  of  nitrites  in  water  is  primarily  the  nitrogenous  organic  matter  origin- 
ally present  and  they  result  from  the  action  of  certain  kinds  of  bacteria.  They  can  be 
lormcd  by  the  reduction  of  nitrates  through  purely  chemical  action. 

Nitrogen  as  Nitrate.  The  picric -ai -id  method  is  the  most  satisfactory  for  the 
dele,  tion  and  t-timation  of  the  nitratrs.  For  this  the  following  solutions  will  be 
ary. 

Pkfndsulpkonic  Add.  Mix  3  grams  of  t  oncentrated  sulphuric  acid  with  9  grams 
of  pure  phenol  and  heat  the  mixture  in  a  steam  oven  at  ioo°C.  for  six  hours.  This 


102  VAVAL   HYGIENE 

substance  frequently  solicits  on  cooling.  It  can  easily  be  rendered  fluid  by  the 
application  of  a  little  heat.  The  formula  for  this  acid  is  C6H4(OH)HSO3. 

Standard  Potassium  Nitrate. — Dissolve  0.722  gram  of  potassium  nitrate  in  1000 
c.c.  of  distilled  water.  Each  cubic  centimeter  of  this  solution  contains  o.oooi 
gram  of  nitrogen  as  nitrite. 

To  50  c.c.  of  the  sample  add  a  drop  or  two  of  sodium  carbonate  solution  and 
then  evaporate  to  dryness  in  a  small  porcelain  dish,  using  a  water  bath  for  the  pur- 
pose. Mix  the  dry  residue  so  obtained  with  i  or  2  c.c.  of  phenolsulphonic  acid. 
Now  add  about  25  c.c.  of  water  and  transfer  to  Nessler  jar,  then  add  ammonium 
hydroxide  until,  after  thoroughly  mixing,  the  liquid  smells  strongly  of  ammonia. 
If  a  yellow  color  develops  nitrates  are  present.  Make  the  volume  up  to  50  c.c 
with  water.  In  a  small  porcelain  dish  evaporate  5  c.c.  of  the  standard  potassium 
nitrate  solution,  treat  this  residue  with  phenolsulphonic  acid,  water,  and  ammonia, 
and  make  up  to  50  c.c.  Each  cubic  centimeter  of  this  solution  will  contain  o.ooooi 
gram  nitrogen  as  nitrate.  Match  the  yellow  shade  produced  by  the  water  with  that 
produced  by  the  standard  nitrate  solution  in  precisely  the  same  manner  as  the  pink 
shades  due  to  nitrites  were  matched  and  make  calculation  in  the  same  way.  Just 
as  in  the  nitrites,  use  a  smaller  quantity  of  the  water  if  the  shade  produced  by  50 
c.c.  of  it  is  darker  than  the  standard,  although  in  this  case  a  new  standard  need  not 
be  prepared. 

Example. — The  color  produced  by  50  c.c.  of  water  was  equaled  by  40  c.c.  from 
jar  containing  the  5  c.c.  of  standard.  Then  40  by  o.ooooi  equals  0.0004  gram  N  as 
nitrate  in  50  c.c.  of  sample.  In  1000  c.c.  there  would  be  0.0004  by  20  equals  0.008 
gram,  and  this  multiplied  by  1000  gives  8.  The  nitrogen  as  nitrate,  therefore, 
amounts  to  8  parts  per  1,000,000. 

Chlorides  when  present  in  a  quantity  larger  than  20  parts  per  1,000,000  seriously 
interfere  with  this  estimation  and  should  be  removed.  This  can  be  done  by  adding 
to  100  c.c.  of  the  sample  a  number  of  cubic  centimeters  of  a  solution  of  silver  sulphate 
corresponding  to  one-tenth  the  number  of  parts  of  chlorine  per  1,000,000,  the 
strength  of  the  silver  sulphate  to  be  2.87  grams  per  liter,  then  making  the  volume 
up  to  200  c.c.  with  distilled  water,  filtering  and  evaporating  100  c.c.  of  this  filtrate 
to  dryness.  This  100  c.c.  of  filtrate  represents  but  50  c.c.  of  sample.  Silver  sul- 
phate can  be  prepared  by  adding  solution  of  sodium  sulphate  to  a  solution  of  silver 
nitrate  and  washing  the  precipitate  with  repeated  portions  of  very  cold  water  until 
every  trace  of  nitrate  is  removed. 

The  nitric  acid  liberated  by  the  phenolsulphonic  acid  converts  an  equivalent 
quantity  of  phenol  into  trinitrophenol  according  to  the  equation: 

CcEUOKQHSO-,  +  3HN03  =  C6H2(OH)(NO2)3  +  H2SO4  +  2H2O. 

Picric  acid  is  not  nearly  so  intense  a  yellow  coloring  matter  as  ammonium 
picrate  and  for  this  reason  the  ammonia  is  added,  the  following  equation  resulting : 

C6H2(OH)(NO2)3  +  NH4OH  =  C6H2ONH4(NO2)3  +  H2O. 

The  principal  source  of  nitrates  is  through  the  oxidation  of  nitrogenous  orgmic 
matter  that  has  entered  water.  In  many  localities  rain  washes  rather  a  not  ible 
quantity  of  nitrate  from  the  atmosphere.  Another  source  is  from  soil  in  which  at- 


WATER  103 

riospheric  nitrogen  has  been  converted  into  nitrate  through  the  action  of  certain 
varieties  of  bacteria  during  the  growth  of  certain  kinds  of  plants. 

Chlorine. — In  the  estimation  of  the  quantity  of  chlorine  present  the  following 
solutions  will  be  required. 

Standard  Silver  Nitrate. — Dissolve  4.795  grams  of  pure  crystallized  silver  nitrate 
in  sufficient  distilled  water  to  make  1000  c.c.  of  solution.  Each  cubic  centimeter 
of  this  solution  will  precipitate  o.ooi  gram  of  chlorine. 

Potassium  Chromate. — Dissolve  2  grams  of  yellow  potassium  chromate  in  100 
c  .c.  of  distilled  water.  To  insure  freedom  from  chlorine  add  a  few  drops  of  the  silver 
nitrate  solution  and  filter. 

Owing  to  the  widely  varying  quantities  in  which  chlorine  occurs,  it  is  essential 
that  a  qualitative  test  be  first  made  to  determine  whether  it  is  present  in  very  small, 
moderate,  or  large  quantity,  for  the  mode  of  procedure  in  the  estimation  will  depend 
upon  this.  To  make  the  qualitative  test  place  about  10  c.c.  of  sample  in  a  test  tube, 
add  2  or  3  drops  of  nitric  acid,  and  then  about  i  c.c.  of  a  strong  (5  per  cent.)  solution 
of  silver  nitrate.  Note  whether  merely  a  slight  opalescence,  a  decided  milkiness, 
or  a  heavy  precipitate  is  produced. 

If  only  an  opalescence  is  produced  in  the  above  test  evaporate  a  large  but  known 
volume  until  its  bulk  is  from  50  to  75  c.c.,  add  8  to  10  drops  of  the  potassium  chro- 
mate, and  then  from  burette  add  the  standard  silver  solution  until  a  permanent 
but  very  faint  pink  tinge  is  obtained.  (It  is  a  mistake  to  add  the  silver  until  a  red 
color  is  produced;  indeed  the  addition  of  the  silver  should  cease  when  the  appearance 
of  the  solution  changes  from  a  brilliant  to  a  dull  yellow.)  Note  the  number  of  cubic 
centimeters  of  silver  solution  required.  This  multiplied  by  o.ooi  will  give  thequan- 
.ity  of  Cl  in  the  volume  of  water  evaporated;  determine  the  quantity  in  loooc.c. 
and  from  this  calculate  the  parts  per  1,000,000. 

\\  hen  tin-  qualitative  test  produces  a  reaction  ranging  from  milkiness  to  a  small 
quantity  of  curdy  precipitate  in  intensity,  concentration  of  the  water  by  evaporation 
is  not  necessary.  Measure  out  100  c.c.  of  the  sample,  add  10  to  15  drops  of  the  potas- 
sium chromate,  and  titrate  with  the  standard  silver  solution  as  before.  The  cal- 
culation of  results  is  made  as  before. 

When  the  reaction  obtained  in  the  qualitative  test  is  productive  of  a  copious 
curdy  precipitate,  small  quantities,  such  as  10,  20,  or  50  c.c.  of  the  sample,  are  diluted 
with  distilled  water  and  titrated  as  in  the  preceding  paragraph.  In  waters  of  this 
class,  weights  rather  than  volumes  should  be  used  for  the  various  estimations. 

Examples. — Qualitative  test  showed  only  a  slight  opalescence.  Evaporated 
200  c.c.  of  sample  to  about  60  c.c.,  added  the  potassium  chromate  and  then  the 
standard  silver  solution,  5  c.c.  of  which  were  required  to  produce  the  faint  pink  color. 
Then  five  times  o.ooi  equals  0.005  gram  chlorine  in  200  c.c.  of  sample  or  0.025  m 
1000  c.c.  Then  0.025  X  1000  equals  25  parts  Cl  per  1,000,000. 

In  another  sample  the  qualitative  test  gave  a  decided  milkiness.  Measured 
100  c.c.  of  sample,  added  potassium  chromate,  and  then  the  standard  silver  solution, 
3  c.c.  of  which  were  required.  Then  3  X  o.ooi  equals  0.003  gram  Cl  in  100  c.c.  of 
sample  and  0.003  X  10  equals  0.03  gram  in  1000  c.c.,  and  finally  0.03  X  1000  equals 
30  parts  of  Cl  per  1,000,000. 

Chlorine  exists  in  water  principally  in  the  form  of  sodium  chloride  and  is  derived 
normally  either  through  the  disintegration  of  rocks  and  soil  or  from  the  air  especially 


104  NAVAL   HYGIENE 

near  the  sea  coast  and  in  close  proximity  to  the  sea  coast  from  infiltration  of  sea 
water.  The  quantity  will  normally  vary  then  with  the  nature  of  the  strata  through 
which  the  water  passes  and  inversely  with  the  distance  from  the  ocean.  Abnormally 
it  is  derived  from  animal  excreta. 

Oxygen-consuming  Power. — The  solution  required  in  this  process  are : 

Standard  Potassium  Permanganate. — Dissolve  0.3925  gram  potassium  perman- 
ganate in  1000  c.c.  of  distilled  water.  Each  cubic  centimeter  of  this  solution  will 
contain  o.oooi  available  oxygen. 

Standard  Oxalic  Acid. — Dissolve  0.7875  gram  of  pure  crystallized  oxalic  acid  in 
1000  c.c.  of  distilled  water.  Each  cubic  centimeter  of  this  solution  should  decolorize 
exactly  i  c.c.  of  the  permanganate. 

Dilute  Sulphuric  Acid. — Pour  75  c.c.  of  pure  concentrated  sulphuric  acid  into 
350  c.c.  of  distilled  water.  Heat  to  boiling  and  add  the  permanganate  solution  little 
by  little  until  the  acid  attains  a  permanent  faint  pink  color.  This  treatment  with 
permanganate  is  necessary  because  sulphuric  acid  frequently  contains  comparatively 
large  quantities  of  oxidizable  substances. 

Although  the  permanganate  and  oxalic  acid  solutions  were  prepared  so  as  to  be 
exactly  equivalent,  it  is  essential  that  their  actual  relation  be  determined  experi- 
mentally. To  do  so  measure  into  a  beaker  exactly  10  c.c.  of  the  oxalic  acid,  add 
approximately  150  c.c.  of  distilled  water  and  25  c.c.  of  the  dilute  sulphuric  acid. 
Heat  nearly  to  the  boiling  point  and  from  a  burette  add  permanganate  solution 
until  a  permanent  faint  pink  color  is  produced.  Note  the  quantity  of  permanganate 
used  as  it  will  be  necessary  to  use  the  figure  in  the  estimation. 

The  oxygen -consuming  power  of  the  water  is  now  carried  out  as  follows:  Into  a 
beaker  of  sufficient  size  measure  200  c.c.  of  the  water,  add  25  c.c.  of  the  dilute  sul- 
phuric acid  and  from  a  burette  15  c.c.  of  permanganate  and  then  boil  this  mixture  for 
ten  minutes,  during  which  time  more  permanganate  is  added  if  the  red  color  present 
tends  to  fade.  Remove  lamp  and  add  oxalic  acid  in  exact  10  c.c.  portions  until  the 
solution  in  beaker  becomes  absolutely  colorless  and  contains  no  brown  or  black 
floccules.  Now  from  the  burette  continue  to  add  the  permanganate  solution  until 
a  permanent  faint  pink  color  is  produced.  From  the  permanganate  added  to  the 
beaker  subtract  a  quantity  equivalent  to  the  total  quantity  of  oxalic  acid  added. 
This  difference  multiplied  by  o.oooi  will  give  the  quantity  of  oxygen  consumed  by 
200  c.c.  of  the  water.  Obtain  the  result  in  parts  per  1,000,000  in  the  usual  way. 

Example. — Found  experimentally  that  it  required  10.1  c.c.  of  the  permanganate 
to  produce  faint  pink  color  with  10  c.c.  of  the  oxalic  acid.  Placed  200  c.c.  of  sample 
in  beaker,  added  25  c.c.  of  dilute  sulphuric  acid  and  then  from  a  burette  (in  which 
the  solution  stood  at  zero)  added  15  c.c.  of  permanganate.  Brought  mixture  to 
boiling  and  after  five  minutes,  because  of  fading  of  red  color,  added  5  c.c.  more  of  the 
permanganate  and  continued  the  boiling.  Removed  lamp  and  added,  by  means  of 
pipette,  exactly  10  c.c.  of  the  oxalic  acid.  The  solution  now  had  a  slightly  brownish 
color,  so  added  exactly  10  c.c.  more  of  the  oxalic  acid.  The  solution  now  became 
colorless.  Then  continued  to  add  from  burette  the  permanganate  solution  until 
faint  pink  color  was  obtained.  On  reading  burette  found  that  the  total  quantity 
of  permanganate  added  was  26  c.c.  Since  20  c.c.  of  oxalic  had  been  added  and  each 
10  c.c.  of  it  was  equivalent  to  10.1  c.c.  of  permanganate  then  10.1  X  2  equals  22.2 
c.c.,  which  must  be  subtracted  from  26  to  find  the  quantity  of  permanganate  con- 


WATER  I05. 

suned  by  the  200  c.c.  of  water.  This  difference  is  5.8  c.c.  Then,  o.oooi  X  5.8 
equals  0.00058  gram  oxygen  consumed  by  200  c.c.  of  water  and  0.00058  X  5  equals 
O.OD2Q  gram  consumed  by  1000  c.c.  Then,  0.0029^  X  1000  equals  2.90,  is  the  oxygen 
consumed  expressed  in  parts  per  1,000,000. 

Nitrites,  hydrogen  sulphide,  and  ferrous  salts  consume  permanganate  and  if 
present,  which  is  occasionally  the  case,  must  be  rendered  inert  by  boiling  the  water 
for  fifteen  minutes  after  the  addition  of  the  dilute  sulphuric  but  before  the  addi- 
tion of  any  permanganate. 

The  oxygen  consumed  or  required  is  an  index  of  the  total  quantity  of  organic 
mutt i-r  present  and  therefore  supposedly  an  index  of  purity.  When  it  is  considered 
th;.t  a  water  may  contain  organic  matter  of  either  animal  or  vegetable  origin  and 
eit  KT  nitrogenous  or  non-nitrogenous  in  nature  and  that  all  these  decompose 
permanganate  with  equal  facility,  it  can  readily  be  understood  that  a  high  oxygen 
consuming  power  does  not  necessarily  indicate  pollution,  but  merely  that  a  large 
quantity  of  organic  matter  is  present.  It  does  not,  like  the  albuminoid  ammonia, 
indicate  any  particular  kind  of  organic  matter. 

Hardness. — The    Clark  soap   method,    while   not   giving   absolutely  accurate 
results,  is  sufficient  for  all  practical  purposes,  although  some  little  experience  is 
ary  if  good  results  are  to  be  expected.     The  following  solutions  are  required: 

Standard  Calcium  Carbonate. — Dissolve  i  gram  of  pure  calcium  carbonate  in  a 
litile  hydrochloric  acid,  evaporate  to  dryness  on  a  water  bath,  then  dissolve  the 
residue  in  a  liter  of  distilled  water.  Each  cubic  centimeter  of  this  solution  contains 
the  equivalent  of  o.ooi  gram  of  calcium  carbonate. 

Standard  Soap  Solution. — Dissolve  10  grams  of  pure  castile  soap  in  a  liter  of  70 
nt.  alcohol  and  filter.  This  solution  must  be  standardized  by  titrating  it 
au  u'nst  a  known  volume  of  the  calcium  carbonate  solution.  This  is  done  as  follows: 
In  a  flask  of  about  200  c.c.  capacity  place  100  c.c.  of  distilled  water.  Then  from  a 
burette  add  soap  solution,  o.i  c.c.  at  a  time,  shaking  vigorously  after  each  addition 
until  a  permanent  lather  forms.  The  lather  should  persist  for  five  minutes.  Note 
tin-  quantity  of  tin-  soap  required.  Repeat  the  experiment  and  take  the  average 
quantity  of  soap  used.  This  will  be  the  quantity  of  soap  required  to  produce  a  lather 
in  100  c.c.  of  distilled  water,  a  figure  that  is  important  and  to  be  used  later.  Now 
clean  out  the  llask  and  plate  in  it  10  c.c.  of  the  standard  calcium  carbonate  solution 
and  90  c.C.  of  distilled  water.  Then  from  a  burette  add  the  soap  solution,  0.25  c.c. 
at  a  time,  shaking  vigorously  bet  wren  each  addition  until  a  permanent  lather  is  pro 
duced.  Note  the  quantity  of  soap  required.  Repeat  the  experiment  and  find  the 
average  quantity  of  soap  used. 

From  the  quantity  of  soap  required  for  10  c.c.  of  calcium  carbonate  plus  the  90 
«•.(  .  of  dMilled  water  subtract  the  quantity  required  for  100  c.c.  of  distilled  water. 
This  will  be  the  number  of  cubic  centimeters  of  soap  solution  used  by  o.oi  gram  of 
calcium  carbonate. 

Two  im|>ortant  points  are  that  the  soap  solution  must  not  under  any  circum- 
st.mces  be  added  in  greater  quantity  than  0.25  c.c.  at  a  time  and  that  rather  vigorous 
•baking  after  each  addition  is  necessary.  In  a  duplicate  determination  these  precau- 
tion-, mu-i  be  .)l.MT\ed  ju-t  as  faithfully  as  in  the  original. 

:>nplc.  One  hundred  cubic  centimeters  of  distilled  water  required  0.6  c.c.  of 
••up  solution  to  produce  a  lather;  10  c.c.  of  the  calcium  carbonate  plus  90  c.c.  of 


106  NAVAL  HYGIENE 

distilled  water  required  11.7  c.c.  of  the  soap.  Then  11.7  minus  0.6  equals  n.i  c.c. 
of  the  soap  required  for  o.oi  gram  of  calcium  carbonate.  Hence  o.oioo  divided  by 
1  1.  1  equals  0.0009;  that  is,  each.  cubic  centimeter  of  the  soap  solution  will  present 
0.0009  gram  of  calcium  carbonate.  The  soap  solution  is  not  stable,  so  it  should  be 
frequently  standardized. 

To  estimate  the  hardness  of  water  place  100  c.c.  of  the  water  in  the  flask  and  add 
soap  solution  from  a  burette,  0.25  c.c.  at  a  time,  shaking  vigorously  between  each 
addition,  until  a  permanent  lather  forms.  Note  the  number  of  cubic  centimeters  of 
the  soap  solution  required;  repeat  the  experiment  and  take  the  average  quantity  of 
soap  used.  From  this  quantity  deduct  the  quantity  of  soap  required  to  produce  a 
lather  with  TOO  c.c.  of  distilled  water.  This  difference  multiplied  by  the  value  of  the 
soap  solution  will  give  the  quantity  of  calcium  carbonate  represented  in  100  c.c.  of 
the  water.  The  quantity  so  found  multiplied  by  10  will  be  the  quantity  in  a  liter. 
Express  the  results  in  parts  per  1,000,000. 

Example.  —  One  hundred  cubic  centimeters  of  water  required  14.6  c.c.  of  the 
soap  solution  to  produce  a  lather;  100  c.c.  of  distilled  water  required  0.6  c.c.  Each 
cubic  centimeter  of  the  soap  equals  0.0009  gram  of  calcium  carbonate.  Then  14.6 
minus  0.6  equals  14  c.c.,  the  quantity  of  soap  required  by  the  calcium  carbonate  in 
100  c.c.  of  the  water.  Fourteen  multiplied  by  0.0009  equals  0.0126  gram,  the 
quantity  of  calcium  carbonate  represented  in  100  c.c.  of  the  water  and  0.126  gram  of 
calcium  carbonate  represented  in  i  liter  of  the  water;  0.126  multiplied  by  1000  equals 
126,  the  hardness  in  parts  per  1,000,000. 

Since  calcium  and  magnesium,  both  of  which  are  generally  present  in  water  in 
varying  quantities,  form  insoluble  soaps,  then  both  these  must  be  satisfied  before  the 
detergent  properties  of  soap  are  available.  This  preliminary  consumption  of  soap 
without  a  return  in  cleansing  property  is  what  is  commonly  known  as  hardness.  Its 
degree,  owing  to  the  varying  composition  of  the  article  ordinarily  known  as  soap,  can 
be  and  is  better  expressed  in  terms  of  some  substance  of  invariable  composition. 
Calcium  carbonate  has  been,  for  obvious  reasons,  selected  for  this  purpose  so  that  the 
hardness  is  said  to  be  equal  to  so  much  calcium  carbonate.  The  true  meaning  of 
this  term  is  that  the  calcium  and  magnesium  salts  present  are  equivalent,  in  precipi- 
tating powers,  to  so  much  calcium  carbonate.  The  reactions  between  soap,  which 
for  reaction  writing  purposes  may  be  considered  as  sodium  stearate,  Na  (CisHssC^), 
and  calcium  and  magnesium  salts  are  — 


CaSO4  +  2(NaC18H35O2)  =  Ca(Ci8H35O2)2  +  Na2SO4. 
MgC03  +  2(NaC18H3502)  =  Mg(C18H35O2)2  +  Na2CO3. 

Hardness  is  of  two  varieties,  temporary  and  permanent.  The  temporary  is  that 
due  to  calcium  and  magnesium  carbonates.  It  is  easily  removed  by  heat  and  filtra- 
tion, hence  the  term  temporary.  The  permanent  is  due  to  all  other  salts  of  these 
metals  which  for  removal  require  the  addition  of  some  reagent.  Hardness  has  little  if 
any  sanitary  significance. 

From  o  to  50  parts  per  1,000,000  is  considered  soft. 

From  50  to  100  parts  per  1,000,000,  moderately  hard. 

From  100  to  300  parts  per  1,000,000,  hard. 

Above  300  parts  per  1,000,000,  very  hard. 


WATER 


I07 


Alkalinity. — This  is  a  measure  of  the  carbonates  present.  The  only  solution 
necessary  is  N/20  sulphuric  or  hydrochloric  acid,  for  the  preparation  of  which  see 
under  "Volumetric  Solutions." 

Alkalinity  is  determined  by  measuring  100  c.c.  of  water  into  a  beaker,  adding  2 
drops  of  methyl  orange,  and  from  a  burette  adding  N/2O  H2SO4  until  a  distinct 
pink  color  is  obtained.  If  desired,  the  alkalinity  can  be  expressed  as  being  equiva- 
lent to  a  quantity  of  calcium  carbonate.  This  quantity  is  obtained  by  multiplying 
the  number  of  cubic  centimeters  of  N/20  acid  required  for  1000  c.c.  of  the  water  by 
0.0025. 

;  mph. — Added  2  drops  of  methyl  orange  to  100  c.c.  of  sample  and  from  burette 
added  N/2O  HjSO*.  It  required  1.5  c.c.  of  this;  hence  1000  c.c.  would  require  15  c.c. 
Then  fifteen  times  0.0025  equals  0.0375  gram  CaCO3;  and  0.0375  times  1000  equals 
37.5  CaCOs;  that  is,  the  alkalinity  is  equivalent  to  37.5  parts  calcium  carbonate  per 
1,000,000. 

Incrustants. — Occasionally  it  is  desirable  to  determine  the  approximate  quantity 
of  scale  that  would  be  formed  by  water  when  used  in  boilers.  This  can  be  found  by 
evaporating  200  c.c.  of  sample  to  dryness  in  a  weighed  dish,  in  exactly  the  same  man- 
ner as  for  total  solids.  Then  cover  the  residue  with  60  per  cent,  alcohol  and  allow  to 
stand,  with  occasional  rotation,  for  twenty  minutes;  then,  without  making  any  effort 
whatever  to  dislodge  any  of  the  residue  from  the  dish,  filter  through  ashless  paper; 
tr;at  the  residue  twice  more  with  60  per  cent,  alcohol.  Dry  filter,  burn,  and  add  ash 
to  dish.  Dry  and  weigh  dish  and  contents.  Increase  in  weight  will  be  scale  forming 
material  in  200  c.c.  of  sample.  Express  the  result  in  parts  per  1,000,000. 

At  times  it  is  necessary  to  clarify  and  decolorize  a  water  before  an  estimation  of 
the  nitrates,  nitrites,  or  chlorine  can  be  made.  This  can  be  accomplished  by  adding 
i  ;*ram  of  alum  to  500  c.c.  of  the  water,  stirring  until  dissolved,  and  then  adding  a  few 
drops  of  strong  sodium  carbonate  solution,  mix  and  allow  to  stand  a  short  time,  dur- 
ing which  a  copious  precipitate  of  aluminum  hydrate  will  form.  Filter.  The  alum 
and  sodium  carbonate  must  not  contain  any  of  the  substances  mentioned. 

It  is  not  possible  to  state  definitely  the  quantity  of  any  particular  ingredient  that 
should  be  present  in  potable  water,  but  in  order  that  a  fair  idea  may  be  had  of  what 
one  might  reasonably  expect  to  find,  the  following  table,  compiled  from  various 
sources,  is-^iven,  the  quantities  being  expressed  in  parts  per  million. 


Source 

Free 
ammonia 

Albuminoid 
ammonia 

Chlorine 

Nitrite 

Nitrate 

Required 
oxygen 

Rain  water  
Spring  water.  .  .  . 

Usually  high  . 
o  to  o.  10.  .  .  . 

Trace  to  o.  10 
Trace  to  o  .  10 

Trace  to  8 

Trace  to  0.5 
Trace  to  2  . 

i  to  2. 

Trace  to  10.  . 

Slight  trace 

from    15  up. 

River  water o  to  0.06. ...     Trace  to  o.  10  3  to  10 Slight  trace   i  to 4. 

Distilled  water o  to  50 


5  to  7. 


In  the  above  table  traces  of  nitrites  arc  stated  to  be  a  normal  ingredient  of  spring 
water,  river  water,  and  deep-well  water.  This  is  true  only  in  limited  sense; 
therefore  it  would  be  better  to  consider  the  presence  of  nitrites,  even  in  traces,  as  a 
suspicious  sign. 


IO8  NAVAL   HYGIENE 

Poisonous  Metals. — The  question  of  poisonous  metals,  especially  lead  and  zinc, 
is  of  such  importance  that  the  plan  of  applying  the  so-called  quick  and  simple  tests 
should  be  condemned,  for  like  many  tests  of  the  kind  experience  has  proven  that  they 
are  of  little  value  except  in  the  hands  of  an  expert. 

Still,  keeping  in  view  the  necessity  for  methods  which  are  not  too  involved,  the 
following  tests  are  given  for  the  detection  of  these  metals  when  occurring  alone. 
Should  the  presence  of  two  or  more  be  suspected  in  the  same  sample  then  recourse 
must  be  had  to  those  methods  which  are  found  in  complete  works  on  qualitative 
analysis. 

Lead . — To  ^  liter  or  more  of  the  water  add  4  to  5  drops  of  sulphuric  acid  and 
then  evaporate  until  the  volume  has  been  reduced  to  about  10  c.c.  Now  add  a  little 
tartaric  acid  and  then  enough  ammonium  hydrate  to  make  alkaline;  boil  for  a  few 
moments  and  filter.  Cool  the  filtrate  and  add  sufficient  acetic  acid  to  make  acid. 
Add  now  a  few  drops  of  potassium  chromate  and  allow  to  stand  for  some  time.  A 
yellow  precipitate  proves  the  presence  of  lead. 

As  lead  occurs  only  in  small  quantities  it  is  important  to  remember  that  the  larger 
the  volume  of  the  water  concentrated  the  more  positive  and  reliable  will  be  the  test. 
Three  or  4  liters  would  give  better  results  than  half  a  liter.  It  is  equally  impor- 
tant to  keep  the  volume  of  solution  as  small  as  possible  after  concentration  has  been 
completed. 

Copper. — Concentrate  as  under  lead  and  filter.  To  the  filtrate,  which  should 
not  be  too  strongly  acid,  add  a  few  drops  of  a  freshly  prepared  solution  of  potassium 
ferrocyanide.  If  a  chocolate  red  or  brown  precipitate  is  obtained,  copper  is  present. 
The  precipitate  disappears  on  the  addition  of  an  excess  of  ammonia,  and  a  blue  solu- 
tion will  result.  Should  the  precipitate  produced  be  white,  lead  or  zinc  and  not 
copper  is  present. 

Zi nc.— Concentrate  as  under  lead,  and  filter.  To  the  filtrate,  which  should  not 
be  strongly  acid,  add  a  few  drops  of  a  freshly  prepared  solution  of  potassium  ferro- 
cyanide. A  white  precipitate  proves  the  presence  of  zinc.  The  precipitate  dis- 
appears on  addition  of  an  excess  of  ammonium  hydrate. 

Lead  and  zinc  give  exactly  the  same  reaction  with  this  test — that  is,  a  white 
precipitate.  It  is  necessary  to  prove  the  absence  of  lead  before  the  test  can  be 
applied  to  zinc. 

No  examination  of  a  specimen  of  water  can  be  complete  without 
a  careful  examination  of  its  sediment — after  centrifuging  if  necessary — 
to  determine  the  presence  of  amoebae  and  of  the  several  water-borne 
animal  parasites,  which  infect  man. 

Permissible  Limits  of  Pollution  of  Water. — The  following  standards 
are  given  as  maximum  permissible  limits  of  pollution: 

Chlorine,  no  limit.  Must  be  considered  in  relation  to  the  chlorine 
content  of  unpolluted  water  in  surrounding  country. 

Bacteria,  not  over  100  per  cubic  centimeter. 

Bacillus  Coli  should  not  be  present  in  more  than  one  of  five  10 
c.c.  samples  of  surface  water,  and  absent  from  ground  water. 


Parts  per  million 

Free  ammonia o .  o^ 

Albuminoid   ammonia.  0.35 

Nitrites None  or  at  most  a  trace  (0.0004) 

Nitrates 1.6 

The  following  is  an  analysis  of  an  excellent  water  taken  from  a  bored 
well  which  now  supplies  water  to  one  of  our  large  camps  (Quantico) : 
Bacteriological. — No  gas  formers  (B.  coli)  in  56.5  c.c. 

Chemical. 

Parts  per  million 


Total  solids 

Chlorine 

Free  ammonia 

Albuminoid  ammonia. 
Nitrites  . 


12.0 
2.0 

o.  14 

0.26 

None 


Nitrates .  .  None 


PURIFICATION 

The  purification  of  polluted  water  is  secured  through 

1.  Sterilization  with  heat: 

(a)  Distillation; 

(b)  Boiling; 

(c)  Heat  exchange: 

The  Forbes- Waterhouse  apparatus. 

2.  Filtration: 

(a)  Domestic  : 

1.  Pasteur-Chamberland; 

2.  Berkefeld,  etc.; 

(b)  Municipal: 

1.  Slow  sand; 

2.  Mechanical. 

3.  Chemical  purification: 

(a)  Alum; 

(b)  Halogen  group,  except  fluorine: 

1.  Bromine; 

2.  Iodine; 

3.  Chlorine; 

(c)  Calcium  hypochlorite; 


110  NAVAL  HYGIENE 

(d)  Sodium  bisulphate; 

(e)  Potassium  permanganate; 
(/)  Hydrate  of  iron; 

(g)  Ozone; 
(h)  Chloramine-T. 
4.  Ultra-violet  rays. 

i.  STERILIZATION  WITH  HEAT 

(a)  Distillation.— This  method  is  best  of  all  methods  of  water 
purification.     Proper  distillation  gives  a  pure  water,  free  of  bacteria 
and  suspended  matter,  as  well  as  dissolved  salts.     Gases  may  go  over 
with  the  distillate  and  in  foul  harbors  may  be  sufficiently  concentrated 
to  produce  gastro-intestinal  symptoms  in  those  drinking  the  distillate. 
All  distilled  water  requires  aeration  to  be  palatable. 

(b)  Boiling. — Boiling  is  the  next  safest  method.     It  kills  micro- 
organisms and  precipitates  the  carbonates,  thus  removing  temporary 
hardness.     The  content  of  organic  matter  in  the  water  is  not  reduced. 
The  water  is  flat  and  needs  aeration.     In  camp  a  perforated  tin  cup, 
stirring  the  water,  or  allowing  it  to  flow  through  the  perforated  bottom 
of  an  elevated  metal  receptacle  into  a  bucket  below  will  render  boiled 
water  palatable.     Boiling  is  available  when  the  elaborate  apparatus  for 
distillation  cannot  be  had.     It  is  usually  practicable  for  the  household 
while  its  expense  would  preclude  its  use  for  the  purification  of  water  for 
general  distribution  in  cities.     When  in  doubt  boil  drinking  water. 
By  so  doing  doubt  and  infection  are  both  removed. 

(c)  Heat  Exchange  Apparatus.— Various  methods  of  heat  exchange 
apparatus  for  sterilization  of  water,  especially  in  the  field,  have  been 
devised.     They  all  depend  upon  the  principle  that  a  volume  of  water 
heated  to  180°  to  2i2°F.  will  give  up  to  a  similar  volume  of  cold  water 
an  amount  of  heat  within   2o°F.  of   the  temperature  of  the  water 
originally  heated.     The  Forbes- Waterhouse  apparatus  is  used  in  the 
field  by  our  Army.     Packed  it  weighs  only  90  pounds.     This  sterilizer 
supplies  25  gallons  per  hour  of  sterile  water,  at  a  temperature  not  over 
15°  above  that  of  the  raw  water.     This  is  the  best  of  the  small  port- 
able heat  exchange  apparatuses. 

Heat  exchange  apparatus  mounted  on  wheels,  capable  of  supplying 
300  gallons  of  water  per  hour  is  in  use  by  certain  foreign  armies. 

While  several  methods  of  sterilization  of  water  by  heat  are  most 
satisfactory  from  hygienic  viewpoint,  they  are  too  expensive  in  their 
operation  to  be  practicable  for  use  on  a  large  scale,  e.g.,  for  city  supply. 


WATER  III 

2.    FlI.Tk.MI<>\ 

Almost   complete   mechanical   removal   of   pathogenic   organisms 
from  a  water  supply  may  be  accomplished  by  some  kinds  of  nitration. 
Filtration  may  be: 

(a)  Domestic  (for  houses) : 

hi.  Pasteur-Chamberland; 
2.  Berkefeld,  etc. 

(b)  Municipal: 

1.  Slow  sand; 

2.  Mechanical. 

(a)  Domestic. — Domestic  filtration  as  generally  practised  in  the 
house  is  a  delusion  and  a  snare.  It  is  worse  than  useless  and  causes  a 
false  sense  of  security. 

Perhaps  the  best  of  home  filters  is  either  the  Pasteur  or  Berkefeld. 
Thi'se  filters  consist  of  tubes  or  " bougies"  of  baked  kaolin,  the  pores 
of  .vhich  are  very  fine.  The  water  to  be  filtered  is  supplied  around  the 
bougies  and  the  filtrate,  after  passing  through -the  walls  of  the  tube,  is 
collected  in  a  reservoir  for  the  purpose.  The  bougies  are  removable, 
bu1  they  are  very  frangible.  Unless  they  are  actually  removed  and 
boi'cd  at  least  twice  a  week  they  are  apt  to  become  breeders  of  disease, 
for  the  arrested  organisms  find  pabulum  in  the  water  and  their  colonies 
actually  grow  through  the  bougie  in  two  or  three  days.  The  danger  of 
this  is  easy  to  see. 

Hamilton  has  devised  an  ingenious  canteen  by  which  polluted  water 
may  be  filtered  through  a  bougie  and  drunk.  It  may  be  desirable 
in  ase  troops  are  operating  in  small  units  where  pure  water  cannot  be 
had.  But  it  is  believed  to  be  unsafe,  for: 

1.  The  bougies  must  be  boiled  daily; 

2.  They  are  very  frangible  and  apt  to  break; 

3.  Their  point  of  union  with  metal  is  not  necessarily  tight  against 
bacteria. 

It  seems  far  more  desirable  to  use  some  chemical  method  in  such 
circumstances. 

Many  varieties  of  domestic  filters,  some  attached  to  the  spigot, 
an  on  the  market  and  are  a  menace  rather  than  a  protection,  either 
be*  ause  of  improper  handling  or  because  of  inherent  deficiencies.  Most 
of  the  domestic  niters  are  useless.  The  best  are  a  grave  menace  unless 
they  are  sterilized  daily. 


112  NAVAL   HYGIENE 

A  Pullman  porter  once  told  the  writer  he  did  not  know  the  source 
of  the  drinking  water  in  his  car,  but  he  knew  it  was  pure,  because,  he 
said  "It  is  filtheyed  every  day."  No  doubt  it  was! 

(b)  Municipal  Filters. — The  municipal  nitration  of  water  is  a  subject 
so  broad  that  it  is  impossible  to  do  more  than  give  it  passing  notice. 
Generally  speaking  municipal  water  supplies  are  derived  from  surface 
water. 

This  water,  from  rivers  or  lakes,  too  frequently  contains  pollution 
which  must  be  removed  by  filtration  or  other  means  of  purification. 

i.  Slow  Sand  Filters. — For  the  purification  of  large  water  supplies 
a  properly  operated  slow  sand  filter  process,  safeguarded  by  chemical 
and  bacteriological  analysis  made  daily,  is  without  doubt  the  best 
system.  It  imitates  Nature's  method  of  purifying  water  and  has  been 
proved  to  remove  99^  per  cent,  of  all  bacterial  growth  from  a  polluted 
water.  The  objections  to  the  slow  sand  filter  are: 

(a)  The  great  initial  cost; 

(b)  The  difficulty  of  location  owing  to  the  large  amount  of  ground 
required. 

Most  waters  before  being  permitted  to  go  upon  the  filter  beds 
should  pass  through,  and  remain  at  least  twenty-four  hours  in  a 
sedimentation  basin  (simply  a  small  lake)  where  the  matter  in  suspen- 
sion is  permitted  to  settle  to  the  bottom.  This  prevents  clogging  the 
filter  bed  by  silt,  and  renders  its  necessary  cleaning  less  frequent. 

A  single  filter  when  empty  is  a  huge  vaulted  chamber,  covering 
about  an  acre  of  ground.  The  roof  is  supported  by  pillars.  The  floor 
is  of  tile  with  a  network  of  drains  let  into  it,  through  which  the  filtered 
water  flows  out  for  use.  On  this  floor  is  placed  first  a  layer  of  coarse 
gravel,  then  one  of  finer  gravel,  next  one  of  sand,  and  last  one  of  fine 
sand.  This  fine  sand  layer  is  about  3  to  5  feet  in  depth,  and  it  consti- 
tutes the  real  filter,  the  rest  of  the  sand  and  gravel  being  used  as  a 
bed  to  keep  the  fine  sand  in  place,  so  it  will  not  be  washed  away  through 
the  drains.  The  gravel  also  aids  in  oxidizing  substances  in  the  water 
during  filtration. 

Above  the  upper  level  of  the  sand  there  is  an  air  chamber  of  perhaps 
10  feet  under  the  roof.  A  roof  is  necessary  to  prevent  freezing  and  the 
growth  of  algae.  This  roof  is  in  turn  covered  by  sod  and  only  an 
occasional  man  hole  showing  on  a  green  lawn  gives  evidence  of  the 
subjacent  filtration. 

Through  these  man  holes  there  is  easy  access  to  the  filter  beds, 


WATER  113 

il though  large  doors  form  the  usual  entrance.  Units  of  this  character 
may  he  constructed  in  number  sufficient  to  supply  the  needs. 

Filter  beds,  when  first  laid,  are  not  efficient.  It  is  necessary  that  a 
slime  layer,  or  "schmutzdecke"  of  the  Germans,  shall  first  form.  This 
jelly-like  deposit  consists  of  minute  animal  life  and  bacteria,  and 
extends  down  into  and  around  the  individual  sand  grains.  It  does  the 
real  work  of  filtration.  It  is  a  biological  filter. 

The  maximum  rate  of  filtration  prescribed  is  not  over  4  inches  per 
hour.  When  the  rate  of  filtration  becomes  slow  the  filter  must  be 
cleaned.  The  " schmutzdecke"  has  become  too  thick  to  allow  the 
water  to  penetrate  through  it.  When  this  occurs  the  water  is  drawn 
oil  the  filter,  and  about  an  inch  of  the  sand  is  removed  by  mechanical 
means.  This  sand  is  carefully  cleaned,  and  when,  by  the  process  of 
cleaning,  the  layer  of  fine  sand  on  the  filter  bed  has  been  reduced  to 
a  thickness  not  less  than  i  foot,  the  cleaned  sand  is  brought  back  and 
put  on  the  filter  bed  again. 

For  convenience  of  operation  filter  beds  (on  a  large  scale)  are  laid 
so  as  to  cover  the  area  of  about  an  acre,  and  when  properly  operating 
\\ill  practically  remove  all  bacteria  from  2,000,000  gallons  of  water  in 
twenty-four  hours  (German  maximum  is  2,500,000). 

Most  important  is  the  daily  control  of  the  filtrate  by  chemical  and 
bacteriological  analyses,  especially  the  latter. 

2.  Mechanical  Filtration. — Mechanical  sand  filtration  is  a  term 
applied  to  the  process  of  forcing  water  under  pressure  through  a  cylin- 
drical filter,  generally  of  wood  or  iron,  -containing  sand  and  quartz 
or  gravel,  with  the  use  of  alum  as  a  coagulant  for  making  a  slime  layer. 

This  method  is  applicable  to  smaller  supplies  than  the  slow  sand 
method,  is  said  to  be  efficient,  and  is  more  easily  managed  than  the 
"slow  sand  process." 

Harrington  states  that  a  method  of  mechanical  filtration  combined 
with  treatment  of  the  water  with  h>  poc  hlorites  has  been  found  to  be 
"more  efficient  than  either  process  alone,  and  has  been  recommended 
by  competent  authorities." 

3.  CHEMK  \i.  Pi  RIM<  \n<  >\ 

In  time  of  war  coal  conservation  may  necessitate  resort  to  chemical 
means  for  purification  of  water  aboard  ship.  Troops  in  the  field, 
especially  small  detachments,  often  must  purify  water  by  chemical 
rieans.  Some  of  these  are  as  follows: 

8 


1 14  NAVAL  HYGIENE 

(a)  Alum. — The  quantity  of  alum  required  will  vary  with  the  chemical 
composition  of  the  water  to  be  purified.     English  authorities  arbitrarily 
place  the  amount  needed  as  6  grains  per  gallon,  while  Harrington  says 
Y±  grain  to  the  gallon.     For  the  successful  action  of  alum  a  small  amount 
of  calcium  carbonate  is  necessary,  and  if  absent  from  the  water  should 
be  supplied  in  the  form  of  limewater.     The  reaction  between  these- 
salts  results  in  the  precipitation  of  alumina  hydrate,  which  is  of  gela- 
tinous consistence  and  in  settling  carries  to  the  bottom   suspended 
microorganisms  and  other  substances. 

Care  should  be  exercised  that  too  much  alum  and  lime  are  not  used 
as  excess  of  either  in  the  water  is  very  undesirable. 

(b)  The  Halogen  Group. — The  halogen  group  are  all  proposed,  with 
the  exception  of  fluorine,  for  use  in  purification  of  water. 

1.  Bromine  is  recommended  for  use  by  troops.     It  is  supplied  in 
2  c.c.  capsules  containing  0.06  gram  of  bromine  in  solution.     Each 
capsule  is  capable  of  sterilizing  i  liter  of  water. 

2.  Iodine  is  recommended  in  similar  circumstances.     Tablets  of 
iodate  of  soda  are  dissolved  in  the  water.     Tablets  of  tartaric  acid 
decompose  the  salt,  and  sodium  sulphite  tablets  are  added  to  render 
the  water  palatable. 

3.  Chlorine. — The  sterilization  of  water  by  chlorine  suggested  some 
time  ago,  after  a  period  of  disuse,  has  been  growing  in  popularity  since 
1908.     It  has  been  used  by  means  of  tanks  into  which  the  gas  has  been 
compressed  and  is  liberated  into  the  water  to  be  purified.     A  far  more 
satisfactory  and  practicable  method  is  the  application  of  chlorine  in 
some    salt    from    which    it    is    readily    liberated,    such   as   calcium 
hypochlorite. 

(c)  Calcium  Hypochlorite. — Perhaps  the  most  conveniently  used 
and  available  salt  for  use  by  the  naval  medical  officer  is  the  calcium 
hypochlorite  issued  by  the  medical  department  of  the  Navy. 

This  salt  pulverized,  placed  in  a  gauze  or  cheese-cloth  bag,  and 
dragged  through  the  water  is  very  effective  in  proportion  of  i  gram  per 
100  hundred  gallons. 

Harrington  attributes  the  following  advantages  to  the  hypochlorite 
process,  viz.: 

1.  Almost  complete  destruction  of  pathogenic  organisms,  especially  those  of 
intestinal  origin; 

2.  Reliability  and  ease  of  application  of  the  chemical,  together  with  small  varia- 
tion of  the  required  dose; 


WATER  115 

Total  absence  of  poisonous  features  either  in  the  chemical  product  as  applied 
the  water,  or  in  any  of  its  resulting  decomposition  products; 

4.  Merely  nominal  cost  of  chemical  and  its  application; 

5.  Speed  of  reaction,  making  unnecessary  any  substantial  arrangements  as  to 
}>;IMIIS  other  than  storage  facilities; 

6.  Substantial  saving  in  the  cost  of  coagulation  of  waters  that  are  of  sufficiently 
umatisfactory  appearance  to  require  clarification  or  nitration; 

7.  Permitting  rates  of  filtration  materially  in  excess  of  those  possible  where  high 
bacterial  efficiency  is  required  of  the  filtration  process  in  the  absence  of  sterilization; 

8.  Reduced  clogging  of  the  filter  beds,  with  consequent  lengthening  of  the  runs 
between  cleanings  due  to  the  destruction  of  various  forms  of  algae. 

Limitations  of  the  process: 

1.  Inability  to  remove  or  destroy  all  of  the  spore-forming  bacteria,  but  which 
kinds  of  bacteria  are  not  considered  to  be  pathogenic  to  man,  at  least  those  common 
to  water; 

2.  Inability  to  remove  bacteria  which  are  imbedded  in  particles  of  suspended 
matter; 

3.  Inability  to  remove  turbidity; 

4.  Inability  to   remove  appreciable  amounts  of  color  or  dissolved  vegetable 
stain; 

5.  Inability  to  remove  organic  matter  appreciably; 

6.  Inability  to  remove  swampy  tastes  or  odors; 

7.  Inability  to  remove  creosote  tastes  or  odors; 

8.  Inability  to  soften  water;  as  a  matter  of  fact  the  addition  of  hypochlorite  of 
lime  usually  results  in  slight  increase  in  the  hardness  of  water,  although  this  is  not 
orcinarily    measurable,   notwithstanding   the   fact   that   the   commercial    product 
usually  contains  a  little  free  quicklime  which  reduces  slightly  the  carbonic  acid  in 
the  water; 

9.  Difficulties  encountered  in  applying  this  process,  except  with  greatest  care, 
to  waters  which  contain  substantial  quantities  of  reducing  agents  or  compounds 
capable  of  oxidation,  such  as  nitrites  and  unoxidized  iron. 

It  appears  to  be  the  consensus  of  opinion  that  this  process  cannot 
re  > lace  nitration. 

(d)  Sodium  Bisulphate.     Sodium  bisulphate,  15  grains  to  the  pint, 
is  said  to  sterilize  water.     This  is  rather  strong  dosage  of  the  salt  for 
continued  administration.     It  may  be  used  if  necessary  on  the  march. 

(e)  Potassium  Permanganate. — Potassium  permanganate  may  be 
added  until  the  water  to  be  purified  retains  a  permanent  pink  color. 
This  has  been  much  used  by  the  British  in  India  and  has  been  found  very 
satisfactory.     "Pinking"  usually  requires  5  centigrams  per  liter,  or 
i  main  per  quart. 

(/)  Hydrate  of  Iron. — A  method  of  producing  hydrate  of  iron  which 
is   tlocculent  and  carries  down  in  its  precipitation  suspended  matter 


Il6  NAVAL    HYGIENE 

in  water  is  employed  in  Europe.  Iron  scraps  are  placed  in  a  cylinder 
containing  water,  and  are  agitated  in  the  water.  The  CC>2  in  the  water 
forms  a  carbonate  of  iron  which  is  oxidized  by  the  air,  and  a  ferric 
hydrate  is  precipitated.  This  method  is  too  expensive  and  unsatis- 
factory to  be  of  general  use. 

(g)  Ozone. — Recently  the  German  army  has  been  employing  an 
ozonizing  process  of  water  purification  which  appears  to  be  exceedingly 
satisfactory.  The  method  seems  to  be  applicable  to  water  purification 
on  a  small  scale. 

Air  which  has  been  dried  by  passing  over  calcium  chloride  is  then 
ozonized  by  an  electric  current,  and  the  water  is  exposed  to  the  ozone 
thus  formed.  The  water  is  said  to  be  sterilized  by  this  apparatus  in 
quantity  up  to  700  gallons  per  hour.  The  apparatus  is  said  to  be 
economical. 

(h)  Chloramine-T. — Recently  a  chloramine  from  the  aromatic 
toluene  has  been  reported  to  be  the  best-known  reagent  for  the  chemical 
sterilization  of  water. 

Water  containing  10,000  organisms  per  cubic  centimeter  may  be 
sterilized  in  ten  hours  when  used  in  proportion  of  0.04  gram  per  liter 
of  water.  No  unpleasant  taste  results. 

Chloramine-T  is  stable,  non-toxic  and  non-corrosive. 

It  is  said  to  be  more  powerful  in  its  action  than  sodium  hypochlorite, 
and  is  easily  manufactured. 

4.  ULTRA-VIOLET  RAYS 

The  sterilization  of  water  by  means  of  the  ultra-violet  ray  is  believed 
by  some  to  be  an  excellent  and  economical  method. 

Turbidity  greatly  decreases  the  sterilizing  power  of  the  rays  for 
they  cannot  pervade  the  water. 

In  a  competitive  test  at  Marseilles  in  1910,  such  method  was  found 
to  be  quite  economical.  The  rays  are  produced  in  a  mercury  vapor 
lamp  enclosed  in  quartz  which  filters  the  red,  green,  and  yellow  rays 
from  the  light  emitted.  The  waters  are  exposed  to  the  rays  (a)  by 
placing  the  lamp  above  the  water  to  be  sterilized,  and  (b)  by  placing 
the  lamp  in  a  chamber  through  which  the  water  is  forced,  and  falling 
against  baffle  plates  is  directed  toward  the  lamp,  i.e.,  toward  the 
location  of  maximum  intensity  of  the  rays. 

This  latter  method  is  said  to  be  the  more  satisfactory.     Small 


WATER 


lamps  of  this  type  have  been  proposed  for  use  in  domestic  purification 
of  water,  the  lamps  being  attached  to  the  spigot  in  a  small  reservoir. 

A  water-purifying  apparatus  has  been  devised  which  may  be  carried 
in  the  escort  wagon  of  a  regiment  and  will  supply  i  quart  per  man 
daily  of  purified  drinking  water. 

Animal  and  vegetable  microorganisms  are  killed  by  this  apparatus. 

Its  motive  power  is  gasolene. 

On  board  ship  where  it  is  necessary  to  have  electrical  power  for 
machinery  and  for  illumination  between  decks,  the  principle  of  sterili- 
•/A\\  ion  of  drinking  water  by  ultra-violet  ray  may  be  worthy  of  considera- 
tion when  the  distillers  may  not  be  operated. 

The  Lyster  Bag. — The  Lyster  bag  has  proved  an  exceedingly  satis- 
factory apparatus  for  use  in  the  chemical  purification  of  water  for 


PlG,    ->8.— Lvst 


stacked  litters.     (Ford.) 


oops  in  the  field.  It  consists  of  a  funnel-shaped  water-proof  bag 
which  resembles  a  truncated  cone  in  appearance.  The  mouth  of  it  is 
kept  <>pen  by  an  iron  ring  hinged  at  opposite  poles  of  one  diameter  so 
that  the  bag  may  be  folded  conveniently  for  packing.  When  used  the 
is  inverted  and  suspended  from  a  tree  limb,  tent  pole  or  even 
from  litters  which  may  be  stood  up  as  would  the  poles  of  a  tepee. 

Near  its  apex  are  several  spring  faucets  from  which  water  may  be 
drawn  These  faucets  discharge  from  the  bag  at  a  point  sufficiently 
fa  •  from  the  apex  to  dec  ant  the  purified  water  without  drawing  off  any 
sediment  which  may  have  settled  to  the  bottom  of  the  bag. 


Il8  NAVAL   HYGIENE 

Chlorinated  lime  is  used  for  the  purification  and  should  be  mixed  into 
a  paste,  then  thoroughly  stirred  up  in  a  small  vessel  of  water,  and  this 
strong  solution  poured  into  the  bag  of  water  to  be  purified.  The  con- 
tents of  the  bag  should  then  be  stirred  thoroughly  and  the  water  should 
not  be  drunk  inside  of  a  half  hour.  A  greater  time  than  this  is  desirable 
and  water  should  be  prepared  at  night  for  use  on  the  following  day. 

Ampules  containing  i  gram  each  of  chlorinated  lime  guaranteed 
to  yield  30  per  cent,  of  chlorine  are  supplied  for  use  with  this  bag,  one 
such  ampule  being  capable  of  sterilizing  a  4o-gallon  bag  of  water. 
Larger  bags  than  the  40-gallon  size  are  made,  but  this  latter  size  affords 
a  sufficient  supply  for  the  daily  use  of  the  average  company  of  100 
men. 

A  sheet  of  one  or  more  thicknesses  of  canton  flannel  should  be  used 
as  a  filter  for  the  removal  of  twigs,  leaves,  animals  and  other  gross 
impurities  before  application  of  the  chlorinated  lime. 

The  lightness,  portability,  and  convenience  of  operation  are  quali- 
ties which  strongly  commend  the  Lyster  bag  for  use  where  chemical 
purification  of  water  is  necessary. 

Chlorinated  water  should  not  be  permitted  to  stand  in  tin  vessels 
since  it  acquires  a  disagreeable  taste.  When  possible  it  should  be 
stored  in  earthen  ware. 

Halozone  is  said  by  Dunham  and  Dakin  to  be  the  best  agent  for 
chemical  purification  of  water.  They  claim  it  will  destroy  B.  typhosus 
in  one-half  hour  when  used  in  proportion  of  one  part  to  300,000  of  water 
and  that  it  is  cheap,  stable,  and  convenient  since  it  may  be  supplied  in 
tablets.  "Halozone"  is  p-sulphon  dichloramino  benzoic  acid. 

The  Darnall  Siphon  Filter.— The  Darnall  siphon  filter  is  an  ingen- 
ious and  more  complicated  apparatus  for  the  purification  of  water  on  a 
small  scale  and  consists  of  a  cylindrical  wire  cage  around  which  are 
wrapped  several  layers  of  canton  flannel  sewed  together,  which  form  the 
essential  "filter  bed"  for  this  filter.  The  ends  of  the  cylinder  are 
solid  metal  plates  from  one  of  which  a  siphon  tube  discharges. 

Alum  (i  to  5  grains  per  gallon)  may  be  used  as  a  precipitant  in  the 
water  to  be  filtered.  Darnall  recommends  a  precipitant  composed  of 
aluminum  hydroxide  and  sodium  carbonate,  in  proportions  to  neutralize 
each  other  chemically.  This  precipitant  is  applied  so  as  to  give  5 
grains  of  the  aluminum  constituent  to  each  gallon  of  water  to  be  filtered. 
The  chemicals  form  a  flocculent  precipitate  which  enmeshes  the 
organisms  and  retains  them  upon  the  flannel  filter  after  the  water 


WATER 


IIQ 


has  passed  through  it.  The  flannel- wrapped  cylinder  is  submerged 
in  the  water  to  which  the  precipitant  has  been  added,  and  the  filtrate 
going  through  the  flannel  enters  the  cylinder  and  may  be  drawn  off 
by  siphon  action,  which  is  started  by  a  special  apparatus  for  the  purpose. 
While  ingenious  and  effective,  this  apparatus,  essentially  a  filter, 
consists  of  several  parts  and  is  less  fool-proof  than  the  simpler  Lyster 
bag  by  which  chemical  sterilization  of  the  water  is  effected.  It  will  be 
observed  that  the  Darnall  apparatus  is  a  bacterial  filter  (and  probably 
the  best  of  filters  for  use  in  the  field)  while  the  Lyster  bag  sterilizes 
the  water  by  chemical  means,  is  more  convenient,  and  equally,  if  not 
more,  effective. 


CHAPTER  X 
LIGHT 

Light  is  defined  as  "the  agent  which  excites  in  us  the  sensation  of 
vision." 

Several  theories  have  been  advanced  in  explanation  of  the  origin 
and  mode  of  transmission  of  light,  among  which  are  the 

1.  Emission  or  corpuscular  theory; 

2.  The  wave  or  undulatory  theory; 

3.  The  electro-magnetic  theory. 

1.  The  emission  theory  assumes  that  luminous  bodies  emit  in  all 
directions  extremely  small  corpuscles  or  particles  of  light  which  proceed 
in  right  lines  from  the  source  with  great  velocity.     It  will  be  observed 
that  this  hypothesis  presupposes  actual  progressive  motion  on  the 
part  of  these  minute  corpuscles. 

2.  The  undulatory  theory  presupposes  that  all  space  and  all  bodies 
(to  a  greater  or  lesser  degree)  are  filled  with  an  all-pervading  elastic 
medium  called  ether,  and  that  the  sensation  of  vision  is  due  to  vibration 
in  spherical  waves  of  this  ether,  which  vibration  is  due  to  infinitely 
rapid  vibration  of  the  molecules  of  the  body  which  is  luminous. 

In  this  theory  actual  movement  of  translation  is  not  supposed, 
the  vibration  affecting  various  molecules  in  turn,  e.g.,  wave  motion  in 
water. 

3.  The  electro-magnetic  theory,  which  has  grown  more  popular 
since  the  demonstrations  of  Maxwell,  holds  that  light  and  electro- 
magnetic movement  are  the  same  and  are  but  manifestations  of  the 
physics  of  ether. 

This  theory  accounts  more  satisfactorily  for  the  various  phenomena 
than  any  theory  yet  evolved. 

Because  of  its  beneficent  influences  the  sun  has  been  worshipped  by 
some,  and  by  others  who  hold  it  in  less  veneration  the  sun  has  been  held 
to  have  great  curative  powers. 

The  Indians  of  Central  America  frequently  are  seen  lying  upon  the 


LIGHT  121 

ground  in  the  bright  sunlight  with  the  sun's  rays  pouring  down  at 
right  angle  to  a  diseased  part. 

This  instinctive  appeal  to  the  sun's  rays  while  empiric  with  the 
Indian  is  based  upon  what  we  regard  today  as  sound  therapeusis.* 

Years  ago  Arloing  and  Buchner  proved  that  light  rays  alone  are  capable  of  killing 
bro'h  cultures  of  pathogenic  bacteria;  while  Ward  in  1892-93  showed  that  spores  of 
K.  .nithracis,  which  withstand  ioo°C.  and  upward,  can  be  killed  by  rays  of  reflected 
light  at  a  temperature  far  below  anything  injurious  or  even  favorable  to  growth  of 
spores.  He  proved  that  the  bacterial  death  occurs  in  the  absence  of  food,  so  it  is 
not  merely  the  effect  of  altered  food.  He  believed  this  action  due  to  blue,  violet 
or  ultra-violet  rays. 

The  sun  is  the  chief  source  of  light.  When  one  of  its  rays  is  passed 
through  a  prism  this  ray  will  be  dissociated  or  analyzed  as  it  were  into 
lev^n  colors,  arranged  in  order  of  their  refrangibility.  They  are 
violet,  indigo,  blue,  green,  yellow,  orange  and  red. 

These  same  colors  may  be  reunited  into  a  ray  of  white  light.  This 
white  light  is  necessary  to  animal  and  vegetable  life,  acts  beneficially 
upon  health,  increases  metabolic  activity  of  the  body,  assists  in  haemo- 
globin formation  and  oxidizes  low  forms  of  animal  and  vegetable  life. 

While  white  light — this  end  product  of  the  combination  of  the  colors 
of  the  visible  spectrum — is  necessary  to  the  vital  processes  of  animal 
and  vegetable  life,  certain  components,  especially  if  in  excess,  may  prove 
deleterious  to  man. 

The  above-mentioned  colors  of  the  visible  spectrum,  are  but  the 
part  which  is  visible  to  us,  of  a  physical  series  the  higher  and  lower 
ranges  of  which  while  invisible  are  physically  demonstrable.  Analogy 
indicates  that  there  are  rays  of  greater  wave  length  at  one  end  of  the 
series  and  of  shorter  wave  length  at  the  other  end  of  this  same  series 
than  we  can  actually  demonstrate  today. 

Red  rays  are  produced  by  much  slower  vibration  than  are  the  violet; 
in  >ther  words  the  wave  length  of  the  red  ray  is  greater  than  that  of  the 
videt:  and  of  the  invisible  spectrum  the  rays  at  the  red  end,  or  the 
invisible  infra-red,  are  longer  than  red,  while  those  beyond  the  violet, 
the  ultra-violet,  are  shorter  than  the  violet. 

The  infra-red  are  heat -producing  rays  while  the  ultra-violet  rays 
produce  chemical  change. 

The  ultra-violet  rays  are  more  highly  refrangible,  are  called  actinic 
or  chemical  rays  and  are  said  to  have  a  wave  length  of  0.00039  mm- 

The  sun's  ultra-violet  rays  are  largely  absorbed  by  the  atmosphere 


122  NAVAL   HYGIENE 

during  the  day,  but  the  light  reflected  from  snow,  water,  sand,  etc., 
contains  a  greater  proportion  of  these  rays  than  does  the  atmosphere. 

Parsons,  Schanz  and  Stockhausen  have  shown  that  the  lens  of  the  human  eye 
absorbs  the  ultra-violet  rays,  and  it  seems  that  these  rays  are  chiefly,  if  not  wholly, 
responsible  for  so-called  snow-blindness,  electric  ophthalmia  and  some  of  the  hyper- 
aesthetic  ocular  conditions  seen  in  the  tropics  as  result  of  glare  of  bright  sunlight  upon 
water  and  white  sand.  These  rays  cause  fluorescence  of  the  lens  in  the  human  eye. 

Glassblower's  cataract  may  be  caused  by  the  same  agent.  It  has 
been  shown  that  the  proportion  of  ultra-violet  rays  emanating  from  a 
certain  light  depends  upon  the  degree  of  incandescence  of  the  carbon 
in  the  flame,  filament,  arc  or  mantle. 

Therefore  one  must  carefully  guard  against  injury  to  the  eyes  of 
those  operating  or  exposed  to  the  intensity  of  the  light  of  the  powerful 
search  lights  used  aboard  ship,  electric  welding,  oxy-hydrogen  work, 
etc. 

Sudden  overwhelming  glare  from  a  very  powerful  light,  or  from  a 
short  circuit,  may  cause  temporary  or  even  permanent  blindness. 

But  these  rays  are  not  an  unmitigated  curse  to  man. 

The  bactericidal  power  of  light  has  been  found  to  be  proportionate 
to  the  number  of  actinic  rays  which  the  light  contains,  therefore  we 
find  in  sunlight  a  powerful  disinfectant  of  streams,  rivers,  the  earth's 
surface,  man's  excreta,  etc. 

Other  rays,  especially  the  infra-red  and  red  rays  (heat  rays),  have 
their  therapeutic  uses  also:  blue — anaesthesia  and  sedative;  red— 
in  small-pox. 

White  light,  so  necessary  to  man's  vital  activities  and  vital  proc- 
esses, must  be  had  either  as: 

1.  Natural  illumination;  or  as 

2.  Artificial  illumination. 

Houses  should  be  constructed  so  that  the  ratio  of  window  area  to 
floor  area  will  be  as  i  to  5,  in  order  to  have  proper  natural  illumination. 

Aboard  ship  this  is  impossible  as  adherence  to  this  ratio  would 
produce  too  great  structural  weakness. 

Artificial  illumination  has  not  been  found  which  will  entirely  replace 
the  healthful  effects  of  good  daylight  upon  the  human  organism. 

When  daylight  cannot  be  had  man  utilizes  artificial  light  for  his 
convenience,  but  not  for  producing  healthful  living  conditions.  All 
are  familiar  with  the  anemic  appearance,  lowered  vitality,  weakness 


LIGHT  1 23 

and  marked  susceptibility  to  disease  of  those  who  habitually  live  in 
cellars  or  darkened  houses. 

Likewise  those  who  have  served  in  the  tropics  have  observed  the 
deleterious  effect  of  prolonged  tropical  service — or  exposure  to  heat 
and  light. 

A  golden  mean  between  exposure  to  the  destructive  direct  sun-ray 
and  darkness  is  desired,  in  other  words  a  light  not  too  intense  and  not 
too  dark  is  needed. 

Excessive  illumination  may  produce  conjunctival  discomfort,  retinal 
hvperesthesia,  erythropsia,  and  "after  images,"  if  not  worse  condition. 

Likewise  eye-strain  is  apt  to  result  from  working  in  too  subdued 
lifjht. 

The  effort  should  be  to  have  a  diffuse  light  which  will  not  necessi- 
tate frequent  rapid  accommodations  to  varied  intensity  of  light. 

Light  should  not  flicker  and  should  be  without  glare. 

White  paper  reflects  80  per  cent,  of  light,  while  blue  green  reflects 
only  12  per  cent.  In  other  words  blue  green  absorbs  88  per  cent,  of 
light.  Obviously  a  blue-green  room  wih1  be  a  dark  room  while  a  white 
room  will  be  a  light  room,  as  it  absorbs  only  20  per  cent,  of  the 
light. 

The  color  of  the  walls,  then,  is  of  much  importance  in  attaining  a 
maximum  of  illumination  in  a  room.  The  prejudice  against  the  use  of 
green  in  coloring  wall  paper  because  of  arsenic  is  said  to  be  unwarranted 
since  the  introduction  of  the  aniline  dyes. 

Perhaps  the  most  ideal  room  for  reading  or  study  is  a  room  with  a 
white  ceiling  barely  tinted  with  yellow,  this  color  extending  to  the 
picture  moulding.  Walls  should  be  greenish  yellow  by  natural  light. 
If  the  room  is  sunny  the  color  should  tend  toward  green,  if  shady  room 
toward  yellow. 

If  necessary,  as  in  offices,  a  darker  dado  of  the  same  colors  may  be 
The  trim  should  be  light.  Window  shades  are  necessary,  else 
there  will  be  areas  of  too  great  illumination. 

At  night  or  in  spaces  where  natural  illumination  is  inadequate  or 
absent,  artificial  lighting  becomes  a  necessity.  This  may  be  direct  or 
indirect. 

Direct  illumination  is  that  which  conies  from  a  visible  source; 
while  indirect  illumination  is  that  which  results  from  placing  the 
lumps  behind  a  screen  on  the  walls  near  the  ceiling,  the  light  being 
thrown  upon  the  ceiling  and  reflected  downward.  This  method  gives 


124  NAVAL   HYGIENE 

a  soft  diffuse  light  and  prevents  retinal  irritation  caused  by  looking  at 
numerous  bright  points,  or  lamps. 

All  satisfactory  artificial  illumination  should  be: 

1.  Of  sufficient  intensity; 

2.  Not  too  intense; 

3.  Should  consume  no  O,  or  a  minimum; 

4.  Should  give  off  a  minimum  of  noxious  gases ; 

5.  Should  not  be  composed  of  harmful  rays  in  dangerous  amount; 

6.  Should  be  of  steady  unflickering,  unstreaked  character,  resemb- 
ling daylight  as  much  as  possible; 

7.  Should  be  economical; 

8.  Should  not  be  dangerous. 

Generally  speaking,  illumination  should  be  proportionate  to  the 
special  needs  of  a  given  case,  e.g.,  the  amount  of  light  necessary  for 
comfortable  reading  would  be  unnecessarily  great  for  illuminating  an 
ordinary  passageway. 

Illumination  by  candles  and  lamps  is  necessary  where  gas,  acety- 
lene, or  electricity  are  not  available. 

The  vitiating  effect  of  candles  or  lamps  upon  the  atmosphere  of  a 
confined  space  is  very  great,  although  the  ill  effects  upon  the  eyes  are 
less  than  those  produced  by  the  more  powerful  illuminants. 

Electricity  is  the  principal  illuminant  in  use  aboard  ship. 

Gas  so  generally  used  in  cities  is  a  mixture  of  several  gases,  is  of 
moderate  intensity  depending  upon  the  variety  of  burner  used;  it 
rapidly  consumes  the  oxygen  in  a  confined  space;  gives  off  roughly  one- 
half  its  volume  of  CO2;  does  not  give  off  a  large  amount  of  harmful  rays; 
tends  to  be  unsteady,  especially  in  open  burners;  is  moderately  expen- 
sive; and  is  very  dangerous  to  life  if  through  accident  the  gas  escapes 
into  a  living  space,  or  through  carelessness  or  ignorance  is  "  blown 
out." 

Electricity  is  unquestionably  the  best  illuminant  provided  certain 
precautions  be  taken. 

In  photometric  work  the  candle  power  is  a  unit  employed  and  is  denned  as  a 
sperm  candle  six  of  which  weigh  i  pound  and  which  burns  120  grains  per  hour. 
This  rather  crude  standard  is  being  replaced  by  the  International  candle  which 
=  i  pentane  candle  (under  normal  atmospheric  conditions)  =  i  bougie  decimale 
=  i  American  candle  =  i.n  Hefner  candle  =  0.104  Carcel  lamp. 

A  foot  candle  is  a  unit  which  represents  the  intensity  of  light  given  by  one  candle 
power  at  i  foot  distance.  Intensity  varies  inversely  as  the  square  of  the  dista  ice. 


LIGHT  125 

It  has  been  found  that  for  ordinary  reading  a  maximum  of  visual  acuity  is*  attained 
\vivli  an  illumination  <>f  i  ' ._,  to  2  foot  candles. 

So  it  would  apprar  that  2  ' -2  foot  candles  illumination  is  sufficient  to  allow  for  the 
inevitable  drh-rioration  of  the  lamp. 

Of  course  this  degree  of  illumination  will  be  unnecessarily  great  in  halls, 
storerooms,  etc. 

The  lamp  should  be  covered  by  some  preferably  clear  glass  shade 
which  will  not  permit  the  filament  to  be  seen,  and  which  will  at  the  same 
time  diffuse  the  light.  Perhaps  the  "Holophane"  shade  is  best. 
These  are  of  various  patterns. 

Of  the  various  forms  of  electric  lamps  on  the  market  the  tungsten 
is  most  economical  in  current  consumption,  powerful,  and  has  the 
longest  life.  Owing  to  the  frangibility  of  the  tungsten  filament,  especi- 
ally when  cold,  its  general  use  aboard  ship  has  been  found  practicable 
only  by  using  a  spring  socket  to  prevent  the  many  jars,  concussion  from 
gun  fire,  etc.,  to  which  it  is  subjected. 

In  order  to  get  the  maximum  of  efficiency  from  an  electric  lamp 
it  should  be  placed  vertically  on  the  ceiling  as  there  is  loss  of  light  in 
having  the  lamp  placed  close  against  a  wall:  Its  horizontal  distribu- 
tion is  greater. 

On  board  ship  air-ports,  hatches,  and  prismatic  "dead-lights"  give 
natural  illumination  by  day.  Certain  parts  of  ships  are  not  reached 
by  daylight,  hence  artificial  illumination  is  employed  day  and  night. 

All  forms  of  artificial  illumination  have  practically  been  discarded 
for  the  electric  light  which  has  proved  a  godsend  to  the  sailor. 

Good  light  and  no  atmospheric  vitiation  mean  much  to  him. 

Generally  the  artificial  illumination  employed  aboard  ship  is  obtained 
i  mm  the  incandescent  electric  lamp. 

The  arc  lamp  has  been  used  in  the  fire-room  of  some  of  the  ships, 
but  has  been  discarded  because  of: 

(a)  Shadows  (not  a  diffuse  light) ; 

(b)  Intensity  of  illumination  given  from  the  uncovered  globe  when 
v  ewed  by  the  eye;  and 

(c)  High  proportion  of  ultra-violet  rays. 

On  some  of  the  newer  large  ships  the  Cooper-Hewitt,  or  mercury 
vapor  lamps  have  been  installed,  but  are  unsatisfactory.  While  this 
liimp  is  very  economical,  its  light  contains  no  red  rays,  hence  the  light, 
instead  of  being  white  is  very  greenish  yellow. 

I    "The  spectrum  of  incandescent  mercury  vapor  consists  mainly  of 


126  NAVAL  HYGIENE 

three  bright  lines,  one  in  the  blue,  one  in  the  green,  and  one  in  the 
yellow"  (Ganot). 

One  authority  states  that  the  mercury  vapor  lamp's  spectrum 
"consists  chiefly  in  two  brilliant  bands  in  the  blue  violet  with  which 
is  combined  ultra-violet  spectrum  five  times  as  long  as  in  the  normal 
visible  spectrum." 

Because  of  its  economy,  diffuseness,  slight  shadow  production,  and 
soft  brilliancy  this  light  is  becoming  adopted  in  industry. 

The  last  word  has  not  been  said,  however,  concerning  the  effect  of 
this  ray  upon  the  body  processes  as  a  result  of  living  under  this  light 
during  working  hours. 

A  light  which  has  high  oxidizing  power,  which  is  productive  of 
ozone,  destructive  of  low  animal  and  vegetable  life,  and  which  when 
concentrated  will  produce  erythema,  vesiculation,  pigmentation  of  skin, 
etc.,  in  the  human  body,  as  well  as  fluorescence  of  the  lens  of  the  eye 
probably  would  have  some  effect  upon  the  metabolic  activities  of 
persons  constantly  exposed  to  it. 

True  it  is  that  the  ultra-violet  ray  is  a  component  of  white  light, 
but  here  we  find  the  rays  combined  with  the  other  rays  of  the  spectrum. 
It  is  possible  that  the  effect  is  negligible,  but  here  is  offered  an  interest- 
ing field  for  investigation. 

The  human  lens  absorbs  the  ultra-violet  ray  as  does  glass.  It  is 
possible  that  these  rays,  although  produced  in  the  vaporization  of 
mercury,  may  be  prevented  from  entering  the  light  leaving  the  lamp 
by  means  of  glass  of  one  of  the  many  kinds  of  which  one  of  the  most 
lauded  is  a  patented  glass  called  "Euphos." 

Aboard  ship  the  tungsten  filament  electric  lamp  in  a  spring  socket 
to  control  the  effect  of  concussion  generally  fulfills  best  the  require- 
ments of  a  satisfactory  illuminant  under  varying  conditions  of  ship  life. 

This  lamp,  in  general,  should  depend  from  the  deck  above  and 
should  be  covered  by  a  stalactite  globe.  The  filament  should  be 
screened.  Electric  lamps  filled  with  nitrogen  are  most  efficient  and 
serviceable. 

The  illumination  should  be  at  the  rate  of  about  2,  not  over  3  foot 
candles  upon  the  normal  plane  of  reading  or  office  work.  More  delicate 
work  upon  darker  objects  than  a  white  page  may  require  stronger  light 
than  2  foot  candles  in  order  to  bring  out  contrasts  of  color  necessary 
to  satisfactory  work. 

The  incident  rays  should  fall  from  above  and  preferably  over  the 


LIGHT  127 

1;  shoulder  so  that  glare  from  a  glossy  page  may  be  prevented,  and  the 
shadow  of  the  hand  does  not  fall  upon  the  page. 

Lamps  upon  walls  or  bulkheads  are  apt  to  produce  discomfort  by 
creating  spots  of  too  intense  illumination.  There  is  also  loss  of  light 
from  this  position.  Generally  speaking  lamps  should  not  be  located 
in  haphazard  manner,  but  should  be  placed  with  due  regard  for  the 
nerds  and  comfort  of  those  who  will  occupy  the  space. 

The  tendency  has  been  toward  liberality  of  distribution  of  lamps 
on  shipboard  in  so  far  as  efficiency  of  the  plant  would  permit,  but  more 
litf  it  on  board  ship  is  needed. 

Scarcely  can  it  justly  be  expected  that  the  ambitious  young  man 
will  fit  himself  for  better  things  if  light  is  not  supplied  to  him  at  the 
tines  when  he  has  respite  from  his  daily  duty. 

Intensity  of  illumination  per  square  inch  in  candle  power  is: 

Carbon  filament 3°°~375 

Tungsten 1000 

Cooper-Hewitt 17 

Nernst 2200 

Maximum  intensity  borne  by  the  eye  without  ill  effect  is  4.25 

idle  power. 

Clear  glass  absorbs  of  light 10  per  cent. 

Holophane  12  per  cent. 

Ground 25-60  per  cent. 

Milky 30-60  per  cent. 

The  useful  life  of  filaments  in  electric  bulbs  has  been  found  to  vary 
greatly,  depending  upon  the  material  of  which  the  filament  is  made  and 
its  preparation.  The  useful  life  of  a  carbon  filament  is  450  hours,  while 
that  of  the  tungsten  filament  is  1000  hours. 

In  tropics  men  should  have  protection  from  extreme  heat  as  well 
a>  intense  light.  The  researches  of  Aron  indicate  that  the  former  is 
the  more  important. 


CHAPTER  XI 
FOOD 

Perhaps  no  essential  to  the  efficiency  of  a  fighting  force  has  received 
so  little  attention  in  detail  as  its  food.  Want  of  proper  food  broke 
the  power  of  Napoleon's  army  in  Poland  in  1806.  It  led  to  his  retreat 
from  Moscow  in  1812.  It  caused  disaster  to  the  British  in  Crimea, 
and  hastened  the  fall  of  Port  Arthur.  Eight  thousand  Russians  were 
in  hospitals  alone  in  Port  Arthur  when  the  fortress  fell.  Most  of  them 
were  sick  of  scurvy,  a  preventable  disease  due  to  improper  feeding. 
Had  they  been  well  fed  and  equipped  these  8000  men  could  have 
delayed  for  a  long  time  the  surrender  of  the  fortress. 

This  need  of  rations  has  been  a  potent  factor  in  shaping  the  world's 
destiny,  and  nations  have  fallen  for  want  of  proper  food  for  their 
troops.  The  great  European  war  now  in  progress  ultimately  may  be 
terminated  because  of  similar  need. 

In  navies  this  want  has  been  greatly  accentuated  and  naval  fighting 
forces,  enervated  by  hardship  and  scant  food  allowance,  have  been 
compelled  to  strike  their  colors  to  a  better-fed  foe. 

The  improperly  fed  man  suffers  not  alone  the  discomforts  of 
starvation,  but  he  falls  easy  prey  to  infectious  disease  and  readily 
succumbs  because  of  his  lowered  resistance  and  vitality. 

So  well  recognized  is  the  foregoing  that  the  legislators  of  the  coun- 
tries having  mercantile  marines  have  enacted  laws  which  prescribe 
a  minimum  of  nutritious  food  per  man,  below  which  minimum  avari- 
cious ship  owners  and  masters  may  not  go  without  rendering  themselves 
liable  to  the  law. 

First,  it  is  necessary  to  determine  what  is  a  proper  food  and  then 
consider  its  preparation. 

A  food  to  meet  all  requirements  must: 
i.  Contain  sufficient  of  the  elements: 

Nitrogen  Magnesium 

Carbon  Sodium 

Hydrogen  Calcium 

Oxygen  Potassium 

Phosphorus  Chlorine 

Sulphur  Iron 

128 


FOOD  I2Q 

maintain  body  weight  in  a  state  of  health  and  to  compensate  for  tissue 
oxi  lation  incident  upon  body  processes  and  work  performed: 

2.  It  must  be  palatable  and  in  such  chemical  combination  as  to  be 
metabolized  readily; 

3.  It  must  be  of  sufficient  bulk  to  stimulate  intestinal  activity,  and 
yet  be  not  too  bulky; 

4.  It  must  be  free  of  poisonous  substances  and  disease -producing 
organisms ; 

5.  It  must  be  in  sufficient  quantity  available  for  use,  its  nature 
In-iii^  governed  by  the  locality; 

6.  It  must  be  in  quantity  and  quality  proportionate  to  the  character 
of  work  to  be  done. 

Food  for  man  must  contain  the  various  elements  mentioned  and  is 
ch icily  composed  of  nitrogen,  hydrogen,  carbon  and  oxygen.  In  combi- 
nation with  these  or  as  condiments  the  other  elements  are  supplied. 
Their  quantity  is  small  but  their  presence  is  necessary  to  man's  well-being. 

More  clearly  to  illustrate  the  relation  of  the  various  foods  to  the 
hu  nan  body,  let  it  be  assumed  that  the  body  is  a  power  plant  engaged 
in  furnishing  power  for  its  effort,  thought,  and  body  processes.  This 
plant  has  a  large  furnace  generating  the  necessary  heat.  A  furnace  in 
operation  consists  of  a  grate  and  framework  in  which  the  fuel  is  being 
l)ii  rued — heat  is  being  generated. 

The  furnace  itself  corresponds  to  the  nitrogenous  portion  of  the 
human  body.  The  integrity  and  constant  repair  of  the  furnace  are 
necessary  to  the  proper  performance  of  its  functions;  so  with  the 
nitrogenous  factor  of  the  human  body,  and  unless  we  keep  this  human 
furnace  in  a  proper  state  of  repair  and  efficiency  by  constantly  adding 
nitrogenous  or  proteid  foods  the  human  furnace  will  collapse. 

Again  if  fuel  is  not  put  into  the  grate  of  the  furnace  and  kept  burn- 
ing the  power  plant  will  lie  idle  and  be  impotent.  Enough  fuel  must 
be  supplied  in  combustible  form  in  order  that  the  activities  of  the 
i  plant  may  be  maintained.  Excess  of  fuel  clogs  the  fires  and 
prevents  free  combustion.  The  flames  are  smothered  in  an  over- 
\\ielmingmassofpartlyburnedfuelandash.  So  with  man.  If  into 
our  human  furnace  we  do  not  put  sufficient  combustible  fuel  the  activi- 
>f  our  human  power  plant  will  not  be  maintained  at  a  normal  degree 
of  efficiency.  If  too  much  is  supplied  the  body's  functions  are  impaired. 
I n -lead  of  wood  and  coal  our  human  furnace  burns  carbon,  in  form  of 
i  a  hohydrates  and  fats. 


130  NAVAL  HYGIENE 

Summarizing,  we  need  nitrogen  (as  protein)  for  our  body  structure 
(of  the  furnace)  and  we  need  carbon  (as  fats  and  carbohydrates)  to 
burn  in  our  furnaces  and  supply  energy  to  our  bodies. 

It  is  remarkable  that  in  utilizing  nitrogen  for  tissue  building  and 
carbon  for  fuel,  both  elements  must  be  in  combination  with  hydrogen 
and  oxygen — the  nitrogen  being  supplied  in  the  proteid  molecule  and 
the  carbon  in  fats  and  carbohydrates. 

For  the  nutrition  of  the  human  body  six  essential  substances 
invariably  are  necessary: 

1.  Protein; 

2.  Carbohydrate; 

3.  Fat; 

4.  Salts; 

5.  Vitamines; 

6.  Water. 

i.  Proteins. — Proteins  are  substances  which  contain  nitrogen,  in 
addition  to  carbon,  hydrogen,  and  oxygen,  and  are  divided  into  (a) 
superior  proteins,  and  (b)  inferior  proteins. 

(a)  Superior  proteins  are  of  animal  origin.     Milk,  meat,  eggs,  and 
fish  may  be  regarded  as  types  of  this  class,  and  are  more  rapidly 
digested  than 

(b)  Inferior  proteins  (vegetable)  which  are  found  in  the  protein 
content  of  bread,  beans,  and  maize. 

The  proteins  of  potato  and  rice  are  intermediately  placed  between 
the  superior  and  inferior  types. 

Thomas  has  shown  that  the  following  daily  allowances  of  protein 
are  necessary  to  prevent  protein  loss  by  the  body: 

Meat  protein 30  grams 

Milk  protein 31  grams 

Rice  protein 34  grams 

Potato  protein 38  grams 

Bean  protein 54  grams 

Bread  protein 76  grams 

Indian  corn  protein 102  grams 

These  figures  show  us  that  it  is  necessary  to  eat  3.4  times  as  much  pro- 
tein from  maize  as  from  meat  if  one  or  the  other  of  these  substance  5  were 
the  sole  source  of  the  nitrogen  supply  necessary  for  the  body's  needs. 
The  minimal  intake  of  protein  varies  in  the  same  individual  with 


FOOD  131 


conditions  of  work,  temperature,  etc.  Chittenden  has  placed  it  at 
from  30  to  80  Drains.  In  addition  to  repairing  the  wear  on  the  protein 
tissues  of  the  body,  protein  diet  increases  heat  production.  The  dis- 
inclination toward  meat  diet  in  the  tropics  and  in  summer  in  temperate 
latitudes  is  Nature's  effort  to  lower  our  heat  production.  It  has  been 
said  that  a  well-cooked  beefsteak  is  the  best  dietary  fortification  against 
cold  weather.  The  diet  of  the  Eskimo  consists  principally  of  protein 
and  fat!  He  requires  little  carbohydrate  to  enable  him  to  withstand 
cold. 

Both  types  of  protein,  superior  and  inferior,  are  heat  producers, 
so  that  a  varied  diet  is  possible  without  reducing  the  protein  intake 
below  permissible  minimum. 

Proteins  supply  heat,  energy  and  repair  to  the  tissues  while  carbo- 
hydrate and  fat  supply  energy,  potential  or  actual. 

American  physiologists  regard  J^  gram  of  protein  per  pound  of 
body  weight  as  the  necessary  daily  allowance.  Excess  of  protein  taken 
as  food  is  burned  as  fuel  or  eliminated  in  the  feces.  Protein  as  such  is 
noi;  stored.  A  part  of  it  may  be  transformed  into  fat  and  stored  as  fat. 
Protein,  animal  or  vegetable,  is  necessary  to  life. 

Protein  must  be  taken  in  the  body  in  considerable  quantity  in 
order  to  maintain  a  nitrogen  equilibrium.  Experiments  prove  that  it 
is  necessary  to  ingest  at  the  very  least  three  times  the  amount  of  nitro- 
gen actually  normally  excreted  during  a  starvation  diet,  before  equi- 
librium is  established. 

Proteins  are  believed  to  be  utilized  (a)  as  actual  structural  proto- 
pla>m,  and  (b)  as  a  circulating  protein  available  for  tissue  building  or 
oxidation. 

Protein  is  believed  by  some  to  be  convertible  into  glycogen  and 
stored  in  the  liver.  Also  there  is  evidence  to  base  opinion  that  protein 
may  be  converted  into  fat  in  the  body  and  stored  as  such. 

From  the  foregoing  it  will  be  seen  that  the  body  ingests  much  more 
nitrogen  as  protein  than  it  metabolizes.  The  excess  of  waste  of  protein 
metabolism  is  urea. 

2.  Carbohydrates. — Man's  food  includes  carbohydrates  of  four 
kinds: 

(a)  Monosaccharids  (glucose,  levulose,  mannose,  galactose); 

(b)  Disaccharids  (cane  sugar,  milk  sugar,  maltose); 

(c)  Polysaccharids  (starch,  glycogen,  dextrose); 

(d)  Pentoses  (in  fruits  and  nucleic  acids). 


132  NAVAL   HYGIENE 

The  first  class  may  be  absorbed  without  digestive  change,  and  is 
desirable  in  food  in  as  great  proportion  as  is  assimilable  and  acceptable. 

The  principal  source  of  man's  carbohydrates  is  starch.  All  starches 
and  sugars  are  converted  into  glucose  in  the  body.  Milk  sugar  is  the 
only  carbohydrate  derived  from  animal  source. 

Carbohydrate  ingested  in  excess  of  immediate  needs  for  actual 
energy  is  converted  into  fat  and  stored  in  the  body.  Not  over  500 
grams  daily  of  carbohydrate  should  be  eaten.  More  than  this  is 
unnecessary  and  tends  toward  fermentation  and  digestive  disturbances. 

Carbohydrates  are  fuel  for  combustion  and  energy  production. 
Their  oxidation  results  in  production  of  COz  and  water.  Excess  of 
carbohydrate  is  converted  into  glycogen  and  stored  in  the  liver, 
especially,  and  in  other  organs  and  tissues,  ready  to  be  discharged  into 
the  circulation  when  required.  Some  carbohydrate  may  be  formed  in 
the  tissues  by  an  excessive  protein  diet. 

3.  Fats. — Fats  are  taken  into  the  body  as  such.     Some  of  the 
carbohydrate  of  food  is  converted  into  fat  and  a  portion  of  the  proteins 
of  food  or  of  body  tissue  may  be  converted  into  fat. 

A  diet  poor  in  fat  tends  to  produce  nutritional  disorder,  especially 
in  children.  Excess  of  fat  above  body  needs  is  stored  or  eliminated  as 
feces. 

So  much  as  200  grams  of  fat  may  be  eaten  daily  and  only  2  per 
cent,  will  appear  in  the  feces,  the  remainder  having  been  utilized. 

Fats  ingested  are  either  oxidized  and  converted  thus  into  energy, 
or  else  are  stored  in  the  body  as  fats.  It  is  stated  that  82  to  92  per  cent, 
of  the  excess  of  fat  in  a  diet  can  be  stored  as  fat. 

When  fat  is  stored  it  is  of  the  same  kind  as  that  ingested  even 
though  it  is  different  from  the  usual  fat  of  the  animal,  e.g.,  experiment 
shows  that  the  melting  point  of  the  fat  of  a  dog  is  about  2o°C.,  but  a 
continued  excessive  diet  of  mutton  fat,  the  melting  point  of  which  is 
about  40°  C.  will  cause  the  melting  point  of  the  fat  on  the  dog  to  rise 
from  2o°C.  (normal  for  dog  fat)  to  4o°C.  (normal  for  mutton  fat). 

4.  Salts. — Mineral  salts  of   calcium,  phosphorus  and  magnesium 
are  found  in  bone.     White  sulphur,  phosphorus,  iodine  and  iron  are 
found  in  combination  in  organic  molecules  in  the  tissues  and  fluids 
of  the  body.     Salts  of  sodium,  potassium,  magnesium,  and  calcium  are 
found  dissolved  in  the  body  fluids  and  free  of  organic  combinations. 

Taylor  has  shown  that  animals  fed  on  a  salt-free  diet  succumb 
more  rapidly  than  if  the  diet  were  one  of  absolute  starvation.  The 


FOOD  133 

inorganic  salts  then  are  necessary  to  the  maintenance  of  animal  life, 
although  the  total  quantity  of  such  salts  in  the  body  is  small  and 
usually  can  be  supplied  in  the  articles  of  food  ordinarily  used  in  the 
varied  diet. 

The  inorganic  substances  required  by  the  body  are  chiefly  Na, 
K,  Fe,  Mg,  P,  S,  Cl  and  Ca.  These  substances  as  found  in  the  body 
are  in  complex  organic  combination — not  free — and  constitute  about 
i  per  cent,  of  the  non-skeletal  parts.  They  find  their  way  into  the 
body  in  the  organic  combinations  with  other  food  stuffs.  Generally 
they  are  taken  in  small  amount  at  a  time  and  perhaps  the  only  ones 
which  are  not  sufficiently  found  in  the  foods  are  Na  and  Cl,  which  are 
added  to  man's  dietary  in  the  form  of  sodium  chloride. 

Absence  of  calcium  from  a  diet  results  in  rickets.  The  need  for 
iron  is  well  known.  Phosphorus  likewise  is  essential. 

5.  Vitamines  are  substances  of  unknown  and  complex  chemical 
composition.  They  come  from  vegetables,  but  if  enough  meat  or 
milk  is  eaten  the  body  will  receive  the  amount  of  vitamines  necessary 
to  growth  and  health,  the  vitamines  being  received  from  the  vegetable 
kingdom  through  the  milk  and  flesh  of  animals  which  man  uses  as  food. 

Hopkins  discovered  vitamines.  Funk  regards  them  as  pyrimidin 
derivatives  and  considers  their  presence  in  food  stuffs  necessary  to  the 
maintenance  of  proper  nutrition. 

So  far  as  is  known  vitamines  are  divided  into  two  classes: 

1.  Class  A,  soluble  in  fats;  and 

2.  Class  B,  soluble  in  water  and  alcohol,  but  not  in  fats. 

Class  B  is  believed  present  in  all  food  stuffs,  animal  or  vegetable. 
P<  lished  rice,  starch,  fats  and  sugar  crystals  do  not  contain  it.  Maize 
has  a  large  content  of  Class  B.  This  class  appears  to  be  destroyed  when 
th>>  food  is  cooked  in  an  alkaline  medium. 

Foods  sterilized  at  high  temperature  appear  to  lose  their  vitamines. 
!•(  r  instance,  it  has  been  shown  by  feeding  experiments  that  growth 
«>f  rats  ceased  when  the  animals  were  fed  upon  a  diet  whose  fat  compo- 
nent was  lard,  but  when  butter  was  substituted  for  lard  the  animals 
commenced  to  grow  rapidly.  From  this  it  would  appear  that  the 
Uncooked  luitter  fat  contained  something  which  was  absent  from  lard 
fa  i  which  had  been  heated. 

This  experiment  of  ()slx»nir  and  Mendel  lirars  out  the  theory  of 
deM  ruction  of  vitamines  by  heat. 

The  \  itaminc  in  rice  is  removed  in  polishing,  and  beri-beri  is  pro- 


134  NAVAL  HYGIENE 

duced  by  eating  polished  rice  from  which  the  pericarp  has  been  re- 
moved. Eijkmann  has  been  able  to  produce  a  similar  condition  in  fowls 
called  polyneuritis  gallinorum  by  feeding  polished  rice  to  fowls,  and  to 
cure  the  condition  after  it  has  been  produced  by  feeding  the  polishings 
to  them. 

Beri-beri,  pellagra,  scurvy,  rickets  and  certain  other  diseases  of 
disordered  nutrition  may  be  due  to  deficiency  in  vitamines. 

Recent  chemical  research  indicates  that  some  ideas  concerning  certain  articles  of 
diet  and  their  food  values  must  be  changed ;  and  that  improved  nutrition  will  follow  a 
combination  of  food  stuffs  based  upon  more  careful  study  of  recent  research.  For 
instance,  the  protein  found  in  peas  and  beans  "is  of  low  biologic  value"  because  of 
its  low  assimilability.  Hitherto  it  has  been  assumed  that  the  high  protein  content  of 
peas  and  beans  caused  these  legumes  to  have  great  nutritive  value. 

McCollum  was  unable  to  make  a  ration  of  plant  seeds  to  cause  normal  growth  in 
rats  and  thinks  that  man  could  not  thrive  upon  such  a  ration.  However,  normal 
growth  and  reproduction  followed  the  feeding  of  a  mixture  of  the  same  kind  of  plant 
seeds  plus  the  leaves.  The  inorganic  constituents  of  the  leaf  are  greater  in  amount 
and  different  in  quality  from  those  found  in  the  seeds.  Leaves  and  seed  appear  to 
possess  a  complementary  relation  to  each  other  in  the  maintenance  of  normal  growth. 

6.  Water. — Water  is  the  most  necessary  of  all  foods.  Atwater 
and  Benedict  have  shown  that  the  body  at  rest  gives  off  935  grams 
(nearly  a  liter)  daily  as  "insensible  perspiration." 

Sixty  per  cent,  of  this  is  from  the  skin  and  40  per  cent,  by  expired 
air.  The  remainder  of  man's  output  of  water  is  from  the  various 
secretions  and  excretions.  In  hard  labor  man  may  give  off  3  to  8 
liters  a  day,  and  this  loss  must  be-compensated  by  water  intake  in  food 
and  jirink.  Under  normal  conditions  man  should  take  about  2% 
liters  of  water  daily,  i  liter  in  solid  food  and  the  remainder  in  fluids. 

Food  values  are  expressed  in  calories.  The  large  calorie  commonly 
referred  to  as  calorie  is  a  unit  which  measures  the  amount  of  heat 
required  to  raise  the  temperature  of  i  kilogram  (2.2  pounds)  of  dis- 
tilled water  from  o°C.  to  i°C.  under  standard  conditions  of  temperature 
and  pressure.  In  other  words  it  is  the  amount  of  heat  necessary  to 
raise  i  kilogram  of  water  i°  C. 

Oxidation  of  carbon  and  fat  in  the  body  has  been  found  to  yield 
the  same  amount  of  heat  that  would  be  produced  by  these  substances 
in  their  combustion  under  conditions  appropriate  for  measuring  heat. 

Protein  is  (a)  partially  oxidized  in  the  body,  and  (b)  partially  lost 
in  the  faeces;  consequently  its  heat  production  in  the  body  is  regarded 
as  about  25  per  cent,  less  than  in  the  calorimeter. 


FOOD  135 


The  following  values  have  been  established  for  the  complete  oxi- 
dation in  the  body  of  the  food  stuffs  named: 

i  gram  of  protein  yields  4.1  calories; 

i  gram  of  carbohydrate  yields  4.1  calories; 

i  gram  of  fat  yields  9.3  calories. 

Rubner  places  the  value  of  a  gram  each  of  carbohydrate  and  protein 
at  4.5  calories.  The  acceptance  of  a  lower  value  (4.1  calories)  is  safer. 

Food  is  used  for  growth  and  upkeep  of  the  body,  maintenance  of 
body  heat,  and  for  work. 

Atwater  as  a  result  of  experiment  concludes  that : 

A  man  performing  no  muscular  labor  requires  270x3  calories; 
A  man  performing  light  muscular  labor  requires  3000  calories; 
A  man  performing  moderate  muscular  labor  requires  3500  calories; 
A  man  performing  hard  muscular  labor  requires  4500  calories. 

The  fasting  adult  in  a  state  of  rest  produces  from  1400  to  1700 
calories  daily  depending  upon  body  weight.  This  heat  production  is 
at  the  expense  of  body  tissue  and  must  be  compensated  for  by  the 
corresponding  food  value  if  body  weight  is  to  be  maintained.  In 
addition  to  this,  food  must  be  taken  as  fuel  to  furnish  energy  for  work 
and  for  increased  heat  production  in  cold  weather. 

Manifestly  the  amount  of  food  taken  will  vary  with  age,  sex,  size 
of  Individual,  work  to  be  done,  season  of  the  year,  and  in  certain  diseases. 
Also  the  proportions  of  components  of  the  dietary  will  vary  depending 
upon  the  climate,  locality,  racial  preference,  and  availability  of  food 
stuffs.  For  instance,  the  diet  of  the  Eskimo  is  principally  of  fat  and 
protein.  That  of  the  Indian  in  the  tropics  is  principally  of  carbohy- 
drate. 

Taylor  states  that  the  Germans  living  on  20  grams  of  fat  daily  are  fat-hungry, 
although  they  have  twice  the  fat  constituent  in  the  diet  of  the  Japanese.  They  are 
said  to  feel  more  keenly  the  reduction  of  fats  than  of  proteins  in  the  diet.  The  con- 
siderable reduction  in  fat  in  the  German  diet  has  caused  the  German  individual  to 
appear  less  fat,  but  the  general  nutrition  does  not  seem  to  be  below  the  needs. 

The  garrison  defending  Ladysmith  were  on  a  diet  having  a  fuel  value  of  1500 
calories  per  day  for  several  months. 

The  daily  ration  of  the  German  prison  camps  is  protein  57  grams;  fat  21  grams; 
carbohydrate  310  grams.  This  ration  has  a  fuel  value  of  1720  calories.  In  contrast 
with  this  meager  allowance  is  that  observed  by  Wood  and  Mansfield  upon  fifty  men 
engaged  in  wood  chopping  in  a  lumber  camp  in  Maine.  These  observations  were 
ma  lr  for  a  period  of  six  days.  The  average  per  capita  intake  was  protein  164.1,  fat 
387.8,  carbohydrate  982.0,  having'a  total  heat  value  of  8o83*calories.| 


136  NAVAL  HYGIENE 

It  has  been  shown  that  35  calories  per  kilo  of  body  weight  will 
maintain  nutrition  for  the  average  size  man  on  light  work. 

The  following  is  a  list  of  average  diets  quoted  from  the  authorities  indicated 

Moleschott 

Grams  Calories 

Protein 130  553 

Fat 40  372 

Carbohydrate 550  2,275 


Total  calories 3,200 

Ranke 

Grams  Calories 

Protein 100  410 

Fat 100  930 

Carbohydrate 240  984 


Total  calories. 2,324 

Voit 

Grams  Calories 

Protein 118  483 

Fat 56  520 

Carbohydrate 500  2,050 

Total  calories 3,o53 

Soldiers  on  Active  Maneuvers  (Voit) 

Grams  Calories 

Protein 135  553 

Fat 80  744 

Carbohydrate 500  2,050 


Total  calories 3,347 

Foster 

Grams  Calories 

Protein 131  567 

Fat 68  632 

Carbohydrate 494  1,825 

Total  calories . .  .  3,024 


FOOD  137 

Atwater 

Grams  Calories 

Protein 125  512 

Fat 125  1,172 

Carbohydrate 400  1,640 


Total  calories 3,324 

The  average  heat  value  of  the  above  rations  is  3045  calories,  and  about  17  per 
ce  nt.  of  this  is  from  protein.  The  average  proportions  of  the  constituents  of  the 
diets  given  by  seven  recognized  authorities  are: 

Protein 121  grams 

Fat 59  grams 

Carbohydrate 510  grams 

figures,  it  will  be  observed,  are  slightly  in  excess  of  those  of  Voit  which  have 
ng  been  accepted.  He  gave  as  an  ideal  dietary:  protein  118,  fat  56,  carbohydrate 
x>.  However,  the  difference  in  caloric  value  is  only  80  calories. 

There  is  a  general  accord  as  to  the  amount  of  carbohydrate  which 
should  constitute  the  diet  of  an  adult  doing  moderate  work.  There 
is  considerable  difference  of  opinion  as  to  the  protein  intake  necessary. 

Chittenden,  in  a  test  upon  soldiers,  reduced  the  protein  ration  to 
o  ic-half  or  one-third  and  kept  the  men  under  observation  for  some  time. 
After  adjustment  to  the  new  conditions  the  body  weight  was  stationary, 
a  ul  the  subjects  are  said  to  have  shown  increase  in  vigor  and  strength, 
and  no  reduction  of  mental  vigor.  Haemoglobin  and  red  cell  count  re- 
mained normal.  From  this  experiment  he  concluded  that  the  long 
accepted  protein  standard  of  Voit  (118  grams)  is  much  too  high  and 
should  be  reduced  by  about  one-half.  He  states  that  50  grams  of 
protein  with  carbohydrate  and  fat  added  to  make  the  total  fuel  value 
of  2 500  calories  is  sufficient  for  the  soldier  at  work. 

r  \pcriment  Chittenden  also  has  proved  that  men  performing  hard  muscular 
uork  may  maintain  a  nitrogen  equilibrium  on  6  to  10  grams  nitrogen  per  day  X 
6  25  =  protein.  Highly  as  his  work  is  esteemed,  it  is  impossible  wholly  to  ignore 
natural  inclination  in  respect  of  this  matter.  That  men  may  subsist  for  several 
rronths  without  loss  of  nitrogen  equilibrium  appreciable  by  present  methods  is 
granted,  but  is  it  not  possible  that  various  proteid  secretions  (internal  included)  may 
g-adually  suffer,  and  that  while  no  appreciable  change  appears  in  one  or  ten  men — 
subjects  of  the  experiment — in  six  months,  may  not  such  restriction  of  the  proteid 
content  no  less  surely  work  toward  gradual  deterioration  in  time  of  the  persons  limit  - 
ing  themselves  to  such  n-strirtrd  protein  diet? 

The  Japanese  live  largely  upon  a  diet  of  rice.  Rice  has  a  protein  content  of  8 
per  cent. — very  small  percentage.  In  addition  they  eat  a  small  amount  of  fish — also 


138  NAVAL  HYGIENE 

low  in  protein,  as  compared  with  beef.  Why  are  the  Japanese  of  small  stature  and 
can  it  be  that  the  low  protein  diet  upon  which  the  Japanese  have  subsisted  for  gen- 
erations is  responsible  in  part  at  least  for  the  shorter  average  duration  of  life  in 
Japan?  While  occasional  instances  of  longevity  are  seen,  the  visitor  to  Japan  is  at 
once  impressed  with  the  paucity  of  aged  persons. 

Again  the  food  of  India  is  largely  a  diet  having  low  protein  content.  These 
people  are  of  our  own  Caucasian,  or  Indo-Germanic  race.  Compare  the  achieve- 
ment of  the  European  Caucasian  since  the  Aryan  Migration  with  the  slow  physical 
deterioration  of  the  great  mass  of  people  of  India.  This  is  sad  in  view  of  the  splen- 
did mentality  which  is  and  has  been  their  pride.  Is  it  unreasonable  to  believe  that 
gradual  starvation,  deprivation  of  protein  in  their  dietary,  may  be  at  least  partly 
responsible  for  the  lagging  behind  of  this  great  people  who  are  ethnically  our  brothers? 

The  effect  of  reduction  in  caloric  value  of  the  ration  in  Germany 
during  the  present  war  has  caused  a  tendency  to  adopt  a  protein  stand- 
ard less  than  that  formerly  considered  necessary,  yet  the  reduction  is 
not  so  radical  as  appears  to  be  advocated  by  the  adherents  to  the  low 
protein  theory. 

A  careful  study  of  available  data  and  of  arguments  for  and  against 
a  low  protein  allowance  leads  one  to  believe  that  100  grams  per  day 
of  protein  is  not  an  excessive  allowance  for  the  individual  of  moderate 
work,  and  that  he  requires  a  total  fuel  value  of  about  3000  calories. 

The  ration  of  the  U.  S.  Navy  is  142  grams  of  protein,  192  of  fat, 
and  492  of  carbohydrate,  giving  a  total  fuel  value  of  4384  calories. 
This  ration  is  excellent  in  quality  and  is  sufficient  in  caloric  value. 

Instinct  is  often  a  good  guide  in  the  selection  of  food  as  to  quality 
and  quantity.  Hard  and  fast  lines  cannot  well  be  drawn  because  the 
appetite  for  food  is  influenced  by  so  many  factors.  For  instance,  it 
has  been  observed  that  resting  dogs  at  a  temperature  of  o°C.  will  de- 
vour with  avidity  food  which  in  quality  and  quantity  would  be  partly 
refused  in  a  temperature  of  33°C. 

The  quantity  of  food  taken  must  be  sufficiently  bulky  to  stimulate 
the  muscle  fibers  of  stomach  and  intestines  to  their  normal  action. 

Arctic  explorers  have  found  great  difficulty  in  attempting  to  live 
upon  concentrated  food  stuffs.  One  explorer  has  told  the  writer  of  the 
relief  from  the  digestive  disturbances  experienced  by  his  party  when 
they  commenced  to  eat  the  hair  of  animals  in  order  to  give  the  nec- 
essary bulk  to  the  food  ingested. 

SOURCES  OF  FOOD 

It  now  seems  desirable  to  consider  foods  from  a  standpoint  of  their 
source. 


ppea 


of  Cuts  of 


Healthy  Beef 


eef  is  the  most  important  of  any  of  the  meat 
of  flesh  foods.  To  be  able  to  judge  of  its  fresh- 
ness and  freedom  from  disease  is  of  great 
practical  value.  The  following  colored  plates 
show  the  appearance  of  some  of  the  principal 
cuts  of  beef  in  the  proper  condition  for  cooking. 
I'.y  ("inparing  the  appearance  of  the  meat 
bought  in  all  markets  with  these  plates  it  is 
possible.*  t<>  form  a  sound  judgment  of  their 
suitability  for  consumption. 


These  seven  Plates  are 
reproduced  by  coun<->\  .it 
Armour  &  Co'..  Chicago 


FOOD  139 

Excluding  water  and  sodium  chloride  we  may  divide  our  food 
stuffs  into  those  of: 

(a)  Animal  origin;  and 

(b)  Vegetable  origin. 

(a)  The  foods  of  the  first  class  embrace  the  flesh  of  animals,  fish, 
milk,  butter,  cheese,  and  eggs. 

Meats  consist  of  large  proportion  of  protein,  average  18  to  20 
per  cent.,  and  a  negligible  amount  of  carbohydrate.  Fat  and  water 
constitute  the  remainder.  The  percentage  of  protein  is  practically 
a  constant,  carbohydrate  negligible,  and  the  amount  of  fats  and  water 
will  vary — more  of  one,  less  of  the  other — lean  meat  containing  more 
water  per  pound  than  fat  meat.  Obviously  pound  for  pound  fat  meat 
contains  more  nutrient  material  than  lean  meat. 

Of  the  various  meats  used  as  food  beef  is  perhaps  the  most 
nutritious,  although  mutton  is  more  digestible.  The  percentage  of 
nutrients  in  the  various  meats  varies  and  must  be  obtained  from  proper 
analytical  tables. 

Meats  from  the  following  sources  should  not  be  used  for  human 
consumption: 

1.  Animals  dead  of  or  killed  while  suffering  from  internal  diseases, 
contagions,  pyaemia,  etc.; 

2.  Animals  killed  by  overdriving; 

3.  Animals  that  have  been  poisoned; 

4.  Cows  with  calf  or  just  after  parturition; 

5.  All  putrid  flesh; 

6.  Animals  harboring  animal  parasitic  diseases  which  are  dangerous 

Kenan. 
Carcasses  of  animals  dead  of  tuberculosis  are  rejected  by  the  U.  S. 
vernment  inspectors  if  there  is  evidence  of  a  general  tuberculosis, 
but  if  a  localized  tuberculous  lesion  is  found  and  a  careful  inspection 
shows  that  the  process  is  not  general  the  carcass  may  be  passed  after 
removal  of  the  tuberculous  focus. 

Good  meat  should  be  red,  neither  pink  nor  purple;  should  have  a 
sweetish  odor;  should  not  pit  on  pressure;  should  be  dry,  i.e.,  should 
scarcely  moisten  the  examining  finger. 

The  ribs  should  be  pink  and  covered  with  pleura,  free  of  adhesion. 
The  flesh  should  be  somewhat  elastic  and  should  have  a  mottled  or 
mjirbled  appearance  due  to  the  presence  of  fat.  Dark  flesh  suggests 
mmatory  conditions  or  improper  bleeding  (sugillation). 


in  la  i 


140  NAVAL  HYGIENE 

If  there  is  doubt  as  to  the  freshness  of  the  specimen  a  skewer  or 
pencil  thrust  deeply  into  the  flesh,  especially  near  bone  or  near  a  joint 
will  bring  away  with  it  a  putrid  odor  if  the  meat  is  decomposing. 
Putrefactive  changes  usually  may  be  detected  in  the  pelvis  first. 

Just  here  a  word  may  be  said  to  warn  against  rejection  of  meat 
of  good  quality  which  may  show  a  putrefying,  foul,  grayish  moist 
surface  due  to  improper  care  of  that  surface.  Often  the  butcher's 
knife  will  remove  a  cut  from  the  surface  and  reveal  sweet  meat  of 
good  quality.  Again  in  dry  atmosphere  a  cut  surface  may  be  dark 
and  grumous  in  appearance  due  to  drying,  yet  it  may  cover  excellent 
meat. 

Beef  is  bright  red,  and  of  quality  described  above.  Bull  meat  is 
usually  very  tough,  stringy  and  not  agreeably  flavored. 

Meat  cooked  during  rigor  mortis  is  tough  although  it  may  be  tender 
before  and  after  rigor  mortis. 

Veal  is  flabby  and  pale  when  compared  with  beef.  Mutton  is 
firm  and  dull  red.  Lamb  is  softer  and  lighter  in  color  than  mutton. 
Pork  is  lighter  in  color,  less  firm  than  beef  or  mutton. 

The  flesh  of  birds  is  not  so  fat  as  that  of  mammals,  hence  is  not  so 
marbled  in  appearance.  Wild  birds  which  have  fed  upon  fish  are 
apt  to  deteriorate  in  flavor  if  kept  too  long. 

Milk. — More  disease  and  death  have  been  caused  by  milk  than 
by  all  other  food  stuffs  used  by  man. 

In  our  country  each  person  consumes  0.6  pint  daily,  and  when  we 
remember  how  difficult  it  is  to  obtain  clean  milk  and  the  impossibility 
of  procuring  sterile  milk  (without  sterilizing);  when  we  remember 
that  this  is  the  only  animal  food  usually  consumed  by  man  in  its  raw 
condition;  when  we  remember  that  milk  and  its  products  constitute 
1 6  per  cent,  of  our  diet  in  the  United  States;  and  when  finally  we 
recall  that  it  forms  one  of  the  best-known  culture  media;  it  becomes 
evident  that  the  ingestion  of  milk  handled  in  a  filthy  manner  or  ac- 
cidently  infected  with  a  pathogenic  organism  is  very  frequent  and  may 
be  tantamount  in  effect  to  drinking  an  equal  volume  of  laboratory  cul- 
ture of  the  organism  in  question. 

As  milk  is  the  ideal  food  for  babes  and  children  a  pure  product  is 
desirable.  "Top  milk"  so  commonly  used  for  children  contains  most 
of  the  bacteria  in  the  bottle  from  which  it  is  taken. 

Composition. — Milk,  a  solution  of  sugar,  proteins,  mineral  matter 
and  fat  in  suspension,  varies  in  specific  gravity  from  1027  to  1035. 


ic  complexity  of  the  various  components  is  dependent  upon  so 
many  factors,  diet,  gestation,  water,  assimilation,  fatigue,  etc.,  etc., 
that  we  shall  give  the  following  simple  analysis  disregarding  much 
of  the  complexity: 

Whole  milk  contains  (cow) : 

Proteins 3.3  per  cent. 

Fat 4.0  per  cent. 

Sugar  (carbohydrate)  5.0  per  cent. 

Mineral  matter.  .  .0.7  per  cent. 
Water 87.0  per  cent. 

The  protein  content  of  cow's  milk  is  three  times  that  of  human 
milk  and  cow's  milk  contains  several  (three  or  four)  times  the  amount 
of  inorganic  salts  that  human  milk  contains.  Usually  limewater, 
cream  and  sugar  are  added  to  cow's  milk  as  may  be  needed  to  make  it 
approximate  more  nearly  human  milk  for  consumption  of  infants. 

The  Milk  Committee  of  the  Board  of  Health  of  New  York  has  established 
three  grades  of  milk : 

(a)  Certified; 

(b)  Inspected; 

(c)  Market  milk. 

(a]    Cert i tied  milk: 

1 .  Frequent  inspections  of  dairy  and  analysis  of  milk; 

2.  Cows  to  be  healthy  as  shown  by  tuberculin  test  and  examination  by  qualified 
veterinarian. 

3.  They  must  be  housed  in  properly  appointed  and  cleaned  stables; 

4.  Scrupulous  cleanliness  must  be  exercised  by  all  persons  handling  the  milk  and 
all  must  be  free  of  tuberculosis,  diphtheria,  typhoid,  etc. 

5.  Milk  must  be  drawn  so  as  to  prevent  contamination,  immediately  cooled 
and  kept  not  above  So°F.,  in  sterilized  bottles  until  received  by  consumer  not 
more  than  thirty-six  hours  after  it  is  drawn. 

6.  Pure  water,  chemically  and  bacteriologically,  must  be  used  in  the  dairy; 

7.  Certified  milk  must  not  contain  over  10,000  bacteria  per  cubic  centimeter. 
(6)   Inspected  milk: 

1.  Conditions  about  the  same  as  to  process  and  delivery  but  not  quite  as  good; 

2.  Should  contain  not  over  100,000  bacteria  per  cubic  centimeter 
(c)    Market  milk: 

i.  Embraces  all  milk  not  included  in  foregoing  specifications. 

Adulterations  of  milk  are: 

Skimming  removes  whole  or  a  part  of  the  cream  and  barring  re- 
daction of  nutrient  fat  is  harmless  to  man. 


142  NAVAL  HYGIENE 

Watering,  dilutes  and  may  add  pathogenic  organisms.  This  is  not 
done  so  commonly  as  formerly. 

Thickening,  coloring,  sweetening  and  alkalinizing  are  done  to  increase 
marketable  quality  of  butter. 

Chemicals  are  prohibited  but  boracic,  salicylic  and  benzoic  acids 
and  formaldehyd  have  been  used. 

Bacteriology. — Bacteria  do  not  pass  through  the  udder  usually 
unless  it  is  involved  in  some  disease  process.  They  grow  up  the 
lacteal  ducts,  which  are  infected  as  result  of  the  drawing  back  into 
the  ducts  of  the  last  drop  of  milk  when  the  pressure  upon  the  teat  is 
released. 

Milk  frequently  shows  a  higher  bacterial  count  than  sewage. 

Diphtheria,  anthrax,  scarlet  fever,  erysipelas,  typhoid  fever, 
tuberculosis,  Malta  fever,  milk  sickness,  septic  sore  throat,  foot-and- 
mouth  disease,  cholera,  and  gastro-intestinal  infections  all  are  conveyed 
at  times  by  infected  milk. 

Milk-borne  epidemics  of  disease  are  explosive,  tend  to  follow  milk 
routes,  occur  among  users  of  milk,  occur  among  people  in  good  cir- 
cumstances (able  to  buy  milk),  and  usually  more  women  and  children 
are  attacked. 

Schiider  has  collected  from  literature  statistics  of  650  typhoid  epidemics  the 
supposed  causes  of  which  had  been  reported;  of  these  no  were  due  to  milk,  462  to 
water,  and  78  to  other  agents. 

Since  typhoid  fever,  tuberculosis,  diphtheria,  scarlet  fever  and  dys- 
entery commonly  are  borne  in  milk,  steps  should  be  taken  to  prevent 
these  infections. 

Three  methods  of  treating  milk  are  in  use  looking  toward  the  pre- 
vention of  diseases  which  might  be  borne  in  raw  milk.  They  are: 

1.  Boiling; 

2.  Pasteurization; 

3.  Buddeizing. 

i.  Boiling. — Janet  E.  Lane-Claypon  has  shown  that  boiled  milk 
suffers  little  loss  of  nutritive  value  and  her  feeding  experiments  on  a 
large  scale  indicate  the  desirability  of  boiling  milk,  thereby  insuring 
sterilization. 

Variot  states  that  among  3000  children  fed  on  milk  heated  to  ioS°C. 
no  case  of  infantile  scurvy  was  seen.  Bresset  reports  over  2000  chil- 
dren fed  on  sterilized  milk  without  apparent  ill  effect.  These  feedings 


FOOD  143 

on  a  large  scale  indicate  that  marked  malnutrition  does  not  follow  the 
feeding  of  milk  made  safe  by  boiling. 

All  milk  on  board  ship  should  be  boiled  before  using,  and  after 
boiling  should  be  kept  on  ice  if  it  is  not  to  be  used  immediately.  Boiled 
milk  should  be  kept  in  the  container  in  which  it  is  boiled  until  ready  to 
be  served. 

2.  Pasteurization. — Pasteurization  is  a  process  in  which  milk  is 
exposed  to  temperatures  intended  to  destroy  pathogenic  organisms 
but  not  sufficiently  high  to  produce  sterilization. 

Pasteurization  is  accomplished  by: 

(a)  The  holding  method; 

(b)  The  flash  method. 

(a)  The  Holding  Method. — In  this  method  milk  is  exposed  to  a 
temperature  of  60°  to  65°C.  for  a  period  of  twenty  to  thirty  minutes. 
It  is  claimed  that  the  specific  causes  of  tuberculosis,  typhoid  fever,  diph- 
theria and  dysentery  are  destroyed  when  milk  is  held  at  6o°C.  for  20 
minutes.     Some  dairies  expose  milk  to  this  temperature  in  bulk,  others 
have  facilities  for  filling  the  bottles,  pasteurizing  the  milk  in  them  and 
then  capping  the  bottles.     This  is  the  ideal  method  of  pasteurization. 

(b)  The  Flash  Method. — This  method  consists  in  raising  the  tem- 
perature of  milk  to  about  i75°F.  for  a  moment  and  then  chilling  it 
rapidly.     The  method  is  unreliable. 

After  pasteurization  the  milk  should  be  chilled  as  rapidly  as  possible 
and  kept  on  ice,  else  rapid  decomposition  will  take  place. 

W.  W.  Ford  and  the  writer,  after  an  examination  of  seventy-eight 
specimens  of  Baltimore  market  milk  showed  that  heat  resistant  spores 
of  aerobic  and  anaerobic  bacteria  may  survive  pasteurization  as  Fliigge 
fir-t  noted. 

They  showed  that  the  organisms  surviving  are  capable  of  causing 
disagreeable  and  unwholesome  changes  in  milk,  converting  it  from  a 
nutritive  food  into  an  undesirable  if  not  dangerous  article  of  diet. 

These  changes  take  place  in  milk  heated  to  any  temperature  from 
65°  to  ioo°C.  and  held  there  for  thirty-five  minutes,  then  kept  at  any 
temperature  from  22°  to  37°C.,  but  not  at  that  of  the  ice-box,  4°  to  6°C. 

They  further  showed  that  spores  of  the  bacteria  causing  these 
changes  survive  in  milk  kept  for  long  periods  (four  to  six  weeks)  and 
can  cause  the  same  changes  in  the  milk  kept  on  ice  when  transferred 
to  a  higher  temperature. 


144 


NAVAL  HYGIENE 


Milk  heated  to  any  temperature  from  60°  to  ioo°C.  should  be  kept 
on  ice,  as  heated  milk  is  far  more  apt  to  decompose  than  raw  milk. 

The  lactic  acid  organisms  are  killed  in  milk  which  is  pasteurized. 
They  cannot  inhibit  the  growth  of  the  gas  bacillus  and  prevent  the 
decomposition  resulting.  Pasteurization  should  not  be  depended 
upon  if  milk  is  to  be  kept  for  even  two  days. 

Of  129  specimens  of  milk  examined  in  their  study  most  of  the 
specimens  had  been  commercially  pasteurized  before  being  subjected 
by  them  to  the  temperatures  mentioned  (65°  to  ioo°C.). 


FIG.  29. — Raw  controls  and  flasks  of  heated  milk  show  no  change  after  being 
kept  in  the  ice-box  for  six  weeks. 

Ford  has  shown  that  the  spore-bearers  which  survive  pasteurization 
are  capable  of  producing  a  substance  in  the  milk  highly  toxic  for  ex- 
perimental animals  when  injected  into  them. 

The  writer  found  that  spores  of  B.  aero  genes  capsulatus  survived 
in  90  per  cent,  of  30  specimens  of  Washington  market  milk  which 
had  been  heated  to  and  held  at  a  temperature  of  85°C.  for  thirty-five 
minutes. 

The  accompanying  figures  illustrate  the  action  of  the  spore-bearers 
which  survived.  The  flasks  in  the  upper  row  in  each  figure  show  the 


FOOD 


145 


raw  controls.  In  Fig.  29  the  flasks  were  kept  in  ice-box  (4°  to  6°C.) 
and  no  change  is  noted  in  either  the  raw  controls  or  the  flasks  which 
had  been  exposed  to  85°C.  for  thirty-five  minutes  (lower  row). 

Fig.  30  shows  specimens  of  the  same  milks  which  had  been  kept 
for  twenty-four  hours  in  a  temperature  of  37°C. 

The  raw  controls  are  scarcely  if  at  all  affected  while  the  lower  row 
shows  decomposition  of  the  clot,  accompanied  by  gas  production  and 
foul  odor  in  the  flasks  which  had  been  heated  as  described  above.  The 


FH,.  jo.  Milk  similarly  treated,  but  kept  at  body  heat.  Controls  show  little 
change  at  end  of  24  hours.  The  heated  milk  has  undergone  explosive  decomposi- 
tion with  gas  formation.  In  the  third  flask,  lower  row,  the  cotton  plug  has  been 
blown  from  the  mouth  of  the  flask. 


explosive  decomposition  commenced  to  be  evident  within  six  hours. 
These  figures  illustrate  well  the  importance  of  cooling  pasteurized  milk 
rapidly  and  keeping  it  on  ice  until  used. 

3.  Buddeizing. — This  is  a  process  recently  employed  along  the 
Baltic  Sea. 

A  small  quantity  of  peroxide  of  hydrogen  is  added  to  the  milk 
which  then  is  subjected  to  a  temperature  of  i22°F.  for  twenty 

Iinutes.     The  heating   drives  off   the  peroxide,   the  taste  is  unim- 


10 


146  NAVAL   HYGIENE 

paired,  and  the  process  is  said  to  be  more  effective  than  commercial 
pasteurization. 

Boil  all  milk  intended  for  use  on  board  ship.  Skim  milk  is  substan- 
tially the  same  as  whole  milk  except  that  the  fat  has  been  removed  as 
cream.  Cream  it  will  be  remembered  contains  over  18  per  cent,  of 
fat. 

Buttermilk  and  skim  milk  are  practically  the  same  from  a  view 
point  of  nutrient  content,  skim  milk  containing  5  calories  of  energy 
per  pound  more  than  buttermilk. 

Butter. — Butter  should  contain  at  least  82.5  per  cent,  of  butter  fat 
in  order  to  comply  with  standard  set  by  Congress.  Later  acts  of  Con- 
gress permit  addition  of  coloring  matter. 

Butter  is  produced  by  agitation  of  milk  until  the  fat  globules  in 
suspension  coalesce  into  granules,  are  removed,  and  "worked"  to  free 
the  butter  of  buttermilk  and  water.  Generally  salt  is  added  to  flavor 
and  preserve  it.  Butter  readily  absorbs  odors,  and  rapidly  becomes 
rancid  at  room  temperature  owing  to  decomposition  of  curd  which 
cannot  wholly  be  worked  out. 

Naturally  the  more  water  that  butter  can  be  made  to  hold  the 
greater  the  profit  to  the  dealer.  Unscrupulous  persons  in  some  sections 
add  gelatine,  or  glucose. 

Both  substances  have  the  quality  of  absorbing  moisture,  conse- 
quently butter  to  which  they  are  added  will  retain  more  water  than 
otherwise.  Such  substances  are  called  butter  "expanders."  Butter 
may  carry  disease.  Twenty-two  per  cent,  of  specimens  examined 
were  found  to  contain  tubercle  bacilli.  Typhoid  bacilli  may  live  in 
butter  for  three  months. 

"Process"  butter  is  a  butter  which  results  from  the  melting,  wash- 
ing, coloring  and  rechurning  of  butter  which  has  undergone  changes, 
become  rancid,  etc.  This  rancid  butter  is  collected  from  various 
sources,  treated  as  above  and  is  sold  as  process  butter  or  as  "butter." 

Oleomargarine  is  sometimes  offered  as  a  substitute  for  butter. 
Oleomargarine  is  made  by  rendering  fresh  beef  fat  (rancid  fat  will  not 
make  "oleo")  in  order  to  separate  the  fat  from  the  tissues.  The  liquid 
fat  is  then  drawn  off  and  kept  at  80°  to  9o°F.  for  a  while,  at  which 
temperature  the  stearin  solidifies,  and  is  separated  from  the  oleo-oil 
which  is  churned  with  milk  or  with  milk  and  genuine  butter  to  impart 
the  butter  aroma,  after  which  it  is  sold  on  the  market  as  oleomargarine. 
It  is  as  nutritious  as  an  equal  volume  of  butter,  is  cheaper,  is  purer 


FOOD  147 

(especially  if  it  is  not  churned  in  milk),  and  little  deserves  the  disre- 
pute into  which  it  has  been  thrown  by  the  vendors  of  butter  who  real- 
ize that  they  must  do  all  in  their  power,  else  oleomargarine  may  lessen 
their  sales,  especially  to  those  who  must  count  their  pennies.  In  its 
manufacture  oleomargarine  must  be  heated  to  a  temperature  that 
kills  any  bacteria. 

Cheese. — Cheese  is  the  product  of  solidifying  milk  or  cream 
and  ripening  same  by  coagulating  the  casein  either  with  rennet  or  lactic 
acid.  It  must  contain  not  less  than  50  per  cent,  of  milk  fat. 

Cheese  is  made  from  milk  of  cows,  goats,  ewes,  mares,  etc.  The 
milk  is  heated  to  about  8o°F.,  then  the  rennet  is  added,  and  after  several 
hours  the  whey  is  drawn  off,  the  curd  is  then  put  into  a  press  and  "sub- 
jected to  gradually  increasing  pressure"  until  most  of  the  whey  is 
forced  out  of  it. 

It  is  then  put  away  to  " ripen."  This  process  may  require  several 
months  or  years. 

The  ripening  process  will  not  progress  thoroughly  unless  the  proper 
bacteria  are  present,  and  unless  the  conditions  favorable  to  their  growth 
are  present;  e.g.,  hyperacidity  will  inhibit,  etc. 

Eggs. — Eggs  form  a  common  article  of  food  either  as  hen's  eggs, 
eggs  from  other  fowls,  roe,  etc.  As  certain  fish  are  apt  to  be  poisonous 
at  spawning  time,  and  as  the  poison  appears  to  be  concentrated  in 
and  about  the  reproductive  apparatus  of  the  sexes,  roe  of  fish  of 
ur  known  character  should  be  taken  cautiously.  The  roe  of  the  gar- 
fish is  said  to  be  poisonous.  Investigations  are  now  in  progress  to 
prove  or  disprove  the  truth  of  this  assertion.  If  poisonous  the  roe 
is  unsuitable  for  making  caviar. 

Ordinarily,  by  "eggs"  we  mean  those  of  hens.  As  marketed  they 
are  of  all  qualities,  from  really  fresh  eggs  to  those  which  are  rotten. 
When  fresh  the  egg  is  an  excellent  food  material,  but  when  of  poor 
quality  it  readily  may  cause  disorder  or  disease. 

Genuine  fresh  eggs  may  be  preserved  in  cold  storage,  brine,  lime- 
water,  sawdust,  paraffin,  petrolatum,  or  liquid  glass  (shellac).  Most 
of  these  agents  close  the  pores  of  the  eggshell  and  prevent  the 
entrance  of  putrefactive  or  pathogenic  organisms. 

It  must  he  remembered  that  the  eggshell  is  porous  like  a  Berkefeld 
filter  rather  than  impervious  to  water  like  glazed  porcelain.  In  other 
words  moisture  may  be  absorbed  through  the  shell,  and  if  water  enters 
by  capillary  attraction,  germs  may  also.  An  egg  placed  in  a  solution 


148  NAVAL   HYGIENE 

of  methylene  blue  will  show  the  blue  on  the  inner  side  of  the  shell 
in  a  very  short  time. 

From  what  has  been  said  it  is  evident  that  eggs  should  not  be 
permitted  to  lie  in  wet  places,  or  in  the  putrefying  remains  of  broken 
eggs. 

Especially  pernicious  are  those  mixtures  of  so-called  fresh  eggs, 
cracked  eggs,  decomposing  eggs,  etc.,  which  are  called  "egg  mixture" 
and  are  largely  used  by  bakers.  Serious  attacks  of  gastro-enteritis 
have  resulted  from  ingestion  of  food  prepared  with  this  mixture, 
B.  botulinus  being  the  chief  cause  of  the  sickness. 

Vegetable  Foods  (Harrington's  classification) : 

1.  Farinaceous — cereals,  legumes; 

2.  Farinaceous  preparations; 

3.  Fatty  seeds  (nuts); 

4.  Vegetable  fats; 

5.  Tubers  and  roots; 

6.  Herbaceous  articles  (" vegetables"); 

7.  Fruits  used  as  "vegetables;" 

8.  Fruits  in  the  narrower  sense; 

9.  Edible  fungi; 

10.  Saccharine  preparations. 

i .  Farinaceous. — (a)  Cereals  generally  are  wheat,  corn,  rice,  rye,  oats, 
barley  and  buckwheat;  all  starchy. 

They  are  all  largely  of  the  same  composition,  although  the  con- 
stituents vary  in  amount.  Wheat  is  of  great  importance  in  that  it 
yields  flour. 

Flour  contains: 

Moisture 12.0  per  cent. 

Proteids 11.4  per  cen 

Ether  extract i.o  per  cent. 

Carbohydrate 75.1  per  cent. 

Ash 0.5  per  cent. 

i oo.o  per  cent. 

White  flour  consists  of  the  cleaning  and  grinding  of  the  grain  and 
bolting  removes  the  bran. 

Graham  flour  is  the  result  of  grinding  the  cleaned  whole  wheat- 
no  bolting. 


FOOD  149 

Good  flour  should  be  slightly  "gritty"  when  between  the  teeth; 
when  taken  into  the  hand  and  squeezed  the  mass  should  retain  its 
shape  upon  release  of  the  pressure  and  should  collapse  when  shaken; 
should  have  slightly  sweetish  taste;  should  have  no  musty  odor; 
and  should  present  no  evidence  of  mould,  or  weevil. 

Corn  is  chiefly  of  value  to  man  as  a  food  material  because  of  the 
rreal  derived  from  it. 

Some  corn  is  eaten  in  the  ear.  Popcorn  is  another  form  in  which 
corn  is  consumed.  Hominy,  samp,  and  meal  are  also  forms  of  prepared 
corn. 

Hominy  is  the  crushed  grain  less  its  hull,  which  is  removed  by 
soaking.  Samp  is  the  whole  kernel  with  the  hull  and  germ  removed. 
The  meal  is  made  by  grinding  the  grain  and  sifting  it.  If  the  germ  be 
included,  however,  the  meal  is  apt  to  decompose  rapidly. 

Corn  meal  contains  (Wiley): 


Moisture 12.57 

Proteins 7. 13 

Ether  extract i  .33 

Total  carbohydrate 78.36 

Ash..  0.61 


From  this  analysis  it  is  seen  that  corn  meal  is  very  nutritious. 

Rye. — Flour  made  from  rye  is  more  like  that  of  wheat  flour  than 
that  from  any  other  cereal.  Its  gluten  is  not  so  good  as  that  of  wheat 
il-mr,  hence  rye  bread  is  not  quite,  but  almost  so  good,  as  bread  from 
\\heat  tlour. 

Barley  is  used  in  making  beer  and  as  a  food  for  invalids.  Recently 
its  use  is  becoming  more  general. 

Oats  are  much  used  as  a  food  for  man.  As  they  contain  no  gluten 
they  cannot  be  made  into  bread  readily.  More  fat  is  contained  in 
oats  than  in  any  other  cereal. 

Oatmeal  is  a  most  common  article  of  diet  and  contains  much 
nutriment. 

Rice. — No  cereal  is  so  poor  in  fats  and  proteids  as  rice,  but  none 
i.-  <o  rich  in  starch. 

It  is  digestible  and  highly  nutritious.  It  is  estimated  to  be  the 
prim-Mai  food  of  one-third  of  the  human  rftce. 

Kncktchriit  is  used  chiefly  for  cakes.  It  has  high  protein  content. 
No  gluten  is  contained,  hence  it  cannot  be  made  into  bread. 


150  NAVAL  HYGIENE 

(b)  Legumes. — This  group,  consisting  of  beans,  peas  and  lentils 
is  characterized  by  a  very  high  protein  content — more  per  pound 
than  meat.  However,  the  protein  is  not  so  digestible  as  that  of  meat. 

Peas  are  nutritious  as  the  following  analyses  indicate: 

Dried  peas: 

Protein 22 . 85 

Fat i .  79 

Starch 52-$6 

Fiber  ash  and  H2O. 

Green  peas: 

Proteid 7.0 

Fat 0.5 

Carbohydrate  including  fiber 16.9 

H2O 74.6 

Canned  peas  are  chiefly  water  (85.3  per  cent.),  hence  contain 
little  nourishment: 

Proteids 3.6 

Fat 0.2 

Carbohydrate 9.8 

One  pound  can  of  peas  then  would  contain : 

Ounces  Grams  Calories 

Proteids.... 0.576=  17.91  =  71.64 

Fat 0.032=     0.99  =  8.91 

Carbohydrate i .  768  =  54 . 99  =  2 19 . 96 


300.51 

If  one  were  to  attempt  to  meet  the  requirements  of  the  Voit  dietary  by  subsist- 
ing on  canned  peas  it  would  be  necessary  to  eat  56  Ibs.  of  canned  peas  per  day! 

(118  grams  proteid  =  about    7  pounds  canned  peas 

,    56  grams  fat  =  about  56  pounds  canned  peas 

500  grams  carbohydrate   =  about    8  pounds  canned  peas.) 
• 
Beans. — Dried  beans  are  very  nutritious,  some  varieties  containing 

almost  25  per  cent,  of  proteid  and  almost  50  per  cent,  of  starch. 

Naturally  the  dried  beans  are  more  nourishing,  as  the  string  beans 
contain  89  per  cent,  water. 

Lentils.— Lentils  are  said  to  ^be  "the  most  nutritious  of  the 
legumes."  Lentils  contain: 


FOOD  151 

Proteids 25 . 70 

Fats 1.89 

Carbohydrates 53-46 

They  deserve  wider  use  as  a  food  stuff  than  has  been  accorded  them 
in  this  country. 

2.  Farinaceous  Preparations. — Sago,  tapioca  and  arrowroot  are  used 
chiefly  in  diets  for  invalids,  or  in  puddings,  etc.     Sago  is  obtained 
from  the  pith  of  the  sago  palm,  which  is  ground,  placed  in  water,  and 
strained. 

Tapioca  comes  from  the  root  of  the  "manihot."  The  starch,  ex- 
tracted with  water,  is  heated  and  forms  masses  which  are  seen  in  the 
market  as  transparent  grains. 

Arrowroot  is  a  starch  obtained  from  the  root  of  "maranta."  It 
is  ground  or  grated  and  dried,  forming  a  bland  powder  about  like  corn 
starch,  which  frequently  is  used  in  its  place. 

3.  Fatty  Seeds. — Nuts  have  high  nutritive  value  but  contain  no 
starch.     Almonds,  cocoanuts,  walnuts,  peanuts,  chestnuts,  are  com- 
monly used. 

Cocoanuts  =  70  per  cent,  fat 

Walnuts      =  60  per  cent,  and  16  per  cent,  proteids 

Peanuts       =  45  per  cent,  and  30  per  cent,  proteids 

Vegetable  Fats. — Under  this  class  come  olive  oil,  cotton  seed  oil, 
and  peanut  oil. 

Olive  Oil. — Olive  oil  is  obtained  by  pressure  from  the  mature 
olive. 

Virgin  oil  is  made  by  pressing  (first  pressure)  mature  selected  olives. 

Pure  olive  oil  should  contain  100  per  cent,  of  fats.  It  is  used  in 
salads  and  cooking. 

Cotton  Seed  Oil. — Cotton  seed  oil  is  obtained  by  pressure  from 
cotton  seeds.  It  is  nutritious  and  cheap,  and  is  used  as  a  substitute 
for  olive  oil. 

Its  chemical  composition  shows  it  to  be  an  excellent  article  of  diet 
and  cheap,  therefore  it  is  deserving  of  wider  use  than  it  has. 

5.  Tubers  and  Roots. — Under  this  class  come  potatoes,  sweet  pota- 
toes, artichokes,  beets,  carrots,  turnips,  and  oyster  plant. 

Potatoes  consist  chiefly  of  starch  from  a  nutrient  viewpoint,  and 


152  •  NAVAL   HYGIENE 

contain  about  18  per  cent,  of  carbohydrate.  Sweet  potatoes  contain 
27  per  cent,  of  carbohydrate. 

Potatoes  contain  potassium  salts.  When  potatoes  are  soaked  and 
boiled  in  water  these  salts  are  lost,  so  is  the  small  amount  of  proteid 
which  is  in  solution  in  the  potato.  Consequently  potatoes  should 
be  steamed — not  boiled — with  skin  intact.  They  should  never  be 
soaked  in  water  and  then  boiled. 

The  potato  is  a  member  of  the  belladonna  family,  and  its  leaves 
are  poisonous.  Also  solanin  which  is  found  in  the  sprouting  potato 
is  quite  poisonous. 

The  Jerusalem  artichoke  from  Italian  girasole  (sunflower)  contains 
about  15  per  cent,  sugar  and  twice  the  proteid  content  of  potatoes. 

Turnips,  carrots,  oyster  plant,  parsnips,  beets,  etc.,  are  all  of  gener- 
ally about  the  same  food  value  in  that  they  supply  bulk  and  some 
nutriment  (about  1.5  per  cent,  proteid;  0.5  fat  and  5  to  17  per  cent, 
carbohydrate). 

6.  Herbaceous   Articles. — Celery,    lettuce,    cresses,    cabbage,    onions, 
etc.,  contribute  mineral  salts  to  the  diet,  and  like  the  roots  and  tubers 
are  more  or  less  antiscorbutic. 

7.  Fruits  as  Vegetables. — Tomatoes,  pumpkins,  squash,  egg  plant, 
cucumbers,  etc.,  fall  in  this  class.     They  supply  salts,  but  while  adding 
to  our  dietary  they  are  chiefly  water  (90  per  cent.). 

8.  Fruits. — Apples,  pears,  cherries,  plums,  peaches,  oranges,  grapes, 
melons,  and  berries  are  all  about  of  the  same  nutritive  value — mostly 
water,  some  sugar,  and  fruit  acids. 

Bananas  and  figs  are  somewhat  better — they  contain  much  higher 
percentage  of  sugar  (banana  20  per  cent,  and  fig  50  per  cent.). 

9.  Edible  Fungi. — Mushrooms  and  truffles  contain  about  12  per 
cent,  nitrogen;  hence  are  of  food  value.     Poisonous  varieties  must  be 
avoided. 

10.  Saccharine  Preparations. — Cane   sugar,  maple  sugar,   glucose 
and  molasses  are  all  of  great  food  value,  glucose  less  than  the  rest. 
They  are  carbohydrate  food;  hence  are  energy  producers. 

Honey. — "Honey  is  a  concentrated  solution  of  sugars,"  73  per  cent. 
Hence  contains  much  carbohydrate.  Honey  from  plants  which  are 
poisonous  to  man  may  prove  toxic.  Numerous  instances  are  recorded 
where  people  have  been  poisoned  by  eating  honey  from  such  source. 
Honeys  made  from  yellow  jasmine  and  rhododendron  are  poisonous. 

Confectionery. — Dyes  and  terra  alba  are  adulterants  used  in  con- 


FOOD  153 

•'  t  ionery.  It  is  reported  that  ground  glass  is  being  added  by  Germans 
to  candy  intended  for  use  by  their  enemies. 

Alcohol. — Alcohol  stimulates  to  great  and  sudden  effort.  Forty 
minutes  after  ingestion  depression  occurs.  It  causes  dilation  of 
peripheral  vessels  with  rapid  heat  dissipation,  hence  is  dangerous  in 
cc-ld  weather.  Is  not  good  food.  It  has  little  use  in  medicine. 

Canned  Foods. — Meats,  milk,  cheese,  and  vegetable  foods  are 
preserved  in  cans. 

These  cans  should  be  carefully  handled.  Badly  dented  cans  may 
have  small  punctures. 

The  top  of  a  sound  can  should  present  a  slight  concavity  which 
results  from  sealing  the  can  while  the  contents  are  hot,  and  the  con- 
traction upon  cooling.  Any  can  whose  top  presents  a  convex  surface 
is  "blown"  and  unsafe,  since  the  convexity  usually  is  due  to  gases  of 
decomposition  of  its  contents.  When  the  integrity  of  the  can  is  broken 
bacterial  growth  may  result  in  poisoning  or  acids  may  be  formed 
which  attack  the  tin  on  the  inner  surface  of  the  can  and  cause  tin 
poisoning. 

If  there  is  question  of  the  wholesomeness  of  the  contents  of  a  can, 
reject  at  once. 

Fish. — Fish  constitutes  a  considerable  component  of  the  dietary 
a-going  population,  and  comes  to  them  canned,  salt,  dried  or 
fresh.  If  properly  dressed  and  put  on  cold  storage  before  decomposi- 
tion commences,  fresh  fish  may  be  kept  indefinitely.  Perlzweig  and 
Davies  have  shown  that  "fresh  fish  similar  in  general  character  to 
flounders  may  be  preserved  for  at  least  two  years  without  undergoing 
any  important  alteration  and  without  materially  depreciating  in 
nutritive  value." 

In  some  countries  fish  is  almost  the  sole  source  of  animal  protein 
in  the  dietary. 

There  are  many  varieties  of  edible  fish,  including  shell-fish.  Some 
fish  arc  constantly  poisonous  for  men,  while  others  are  toxic  only  at 
certain  periods  during  their  lives.  Fresh  fish  require  to  be  handled 
very  carefully,  as  they  tend  toward  rapid  decomposition  and  produc- 
tion of  poison  dangerous  to  man. 

Fish  diet  ha>  been  >U|>J><>M  <l  t«>  cause  lepra,  and  to  this  diet  have  been  attributed 
qualities  which  tend  toward  brain  development  and  great  mental  strength.  It  has 
not  been  shown  that  fish-consuming  people  are  unusually  susceptible  to  leprosy,  nor 


154  NAVAL   HYGIENE 

is  it  recorded  that  a  people  whose  chief  animal  food  is  fish,  the  Esquimaux  for  exam- 
ple, are  possessed  of  exceptional  brain  power. 

It  seems  that  these  two  above-mentioned  beliefs,  which  have  been  so  tenaciously 
clung  to  by  many,  are  little  more  than  widespread  superstitions. 

Flesh  of  all  fishes  (and  the  edible  mollusks  and  crustaceans  are 
included  in  this  term)  has  a  high  protein  content,  but  the  fat  content 
as  a  rule  is  small  compared  with  meat,  e.g.,  beef. 

Certain  fishes  are  edible  the  year  round,  others  are  poisonous  to 
man  throughout  the  year  or  during  certain  seasons  only.  Again  some 
fishes,  and  especially  mollusks,  are  toxic  to  man  only  in  certain  localities. 

The  flesh  of  freshly  killed  fish  is  much  paler  in  color  than  is  that  of 
mammals.  It  should  sink  if  thrown  in  the  water.  Floating  is  due 
to  gases  of  decomposition.  It  should  be  firm  to  pressure,  of  sweet  odor, 
should  not  present  discolored  spots,  should  not  be  too  watery  or  slimy, 
and  should  not  readily  separate  from  the  bone.  The  eyes  of  the  fish 
should  not  be  sunken  and  of  ground  glass  appearance.  The  cornea 
should  be  clear.  Suspect  gutted  fish  unless  in  ice.  Evisceration 
is  presumptive  evidence  against  the  freshness  of  fish.  It  may  have  been 
gutted  to  prevent  decomposition  and  to  enable  its  keeping.  The 
gills  should  be  fresh  and  pink  and  the  scales  should  not  separate  readily 
from  the  skin.  Fish  in  market  usually  are  in  ice  and  have  been  gutted. 
While  wholesome,  the  flavor  is  impaired  by  the  preservation  in  ice. 

In  examining  a  fish  seize  it  by  the  tail  and  shake  it  sharply  near 
the  examiner's  ear.  Crackling  due  to  separation  of  vertebral  segments 
indicates  that  the  fish  is  not  fresh. 

Some  fish,  e.g.,  flounders,  have  soft  meat.  Fish  from  clear  streams 
or  clear  sea  and  sandy  bottom  are  apt  to  have  flesh  of  better  texture 
than  those  from  muddy  water  and  muddy  bottoms. 

Fish  from  great  depths  are  repulsive  in  appearance  and  undesirable 
because  of  the  quality  of  their  flesh.  All  shell  fish  decompose  rapidly, 
hence  should  not  be  kept. 

Naturally  dried  fish  contains  less  water  and  more  protein  per  pound, 
but  it  is  not  so  digestible  as  fresh  fish.  It  is  much  used  and  supplies 
considerable  protein. 

Canned  fish  is  generally  preserved  in  tins.  These  should  not  be 
opened  until  ready  for  cooking,  otherwise  poisoning  may  occur.  Stan- 
nates  may  cause  it. 

Fish  caught  in  the  tropics  should  be  kept  alive  if  possible  until 
time  for  their  preparation  for  cooking.  If  this  is  impracticable  ':hey 


FOOD  155 

should  be  eviscerated  and  kept  in  the  shade  in  sea  water  if  better 
facilities  for  care  are  not  available.  Not  more  than  six  hours  should 
elapse  between  the  death  and  cooking  of  fresh  fish  in  the  tropics  unless 
the  eviscerated  fish  are  placed  in  cold  storage. 

No  fish  should  be  eaten  which  are  not  known  to  be  fit  for  food. 
The  sojourner  in  the  tropics  will  do  well  to  inquire  of  the  natives  as  to 
the  edibility  of  fish  with  which  he  is  unfamiliar.  It  is  a  fairly  good, 
bin  not  infallible  rule,  that  poisonous  fishes  are  repulsive  in  appearance. 
Possibly  Nature  intended  this  sense  of  repulsion  to  be  a  guide  to  man 
in  the  choice  of  fish  for  food. 

In  certain  tropical  waters  large  sea  turtles  may  be  eaten.  They 
make  excellent  soups,  and  if  properly  cooked  the  meat  may  be  used, 
though  it  is  apt  to  be  tough. 

At  times,  however,  food  stuff  from  the  sea  is  kept  for  some  time;  for  instance  in 
Tahiti  the  writer  saw  a  sauce  made  from  a  variety  of  shell  fish,  the  flesh  of  which  is 
pulpefied,  mixed  with  lime  made  from  burnt  coral,  placed  in  a  bamboo  joint 
over  the  top  of  which  was  tied  a  banana  leaf,  and  allowed  to  stand  about  six  weeks. 
This  mixture  was  used  as  a  sauce  upon  raw  fish,  and  no  ill  effects  are  known  to  have 
followed  the  eating  of  this  delicacy. 

On  the  Bering  Sea  coast  of  Alaska  some  of  the  natives  bury  freshly  caught  salmon 
in  the  ground  and  exhume  it  after  the  expiration  of  an  interval  of  time  which  experi- 
ence has  taught  them  is  sufficiently  long  to  ripen  the  fish  for  their  palates.  This  par- 
tially decomposed  flesh  is  much  relished  by  them  and  appears  to  produce  no  ill 
effect.  The  same  natives  eviscerate  salmon  and  hang  it  up  to  dry  in  the  sun  to 
supplement  their  winter  food  supply. 

Mussels,  clams,  oysters,  and  lobsters  are  used  as  food.  Clams 
and  oysters  are  more  commonly  used  because  of  their  quantity  and 
availability. 

Oysters  are  frequently  used  for  food.  While  tasty  and  palatable 
their  food  value  is  extremely  small. 

Care  should  be  exercised  as  to  the  source  of  oysters  eaten  raw. 
It"  i he  oyster  beds  are  in  proximity  to  the  outfall  of  large  sewers  con- 
tamination of  the  oysters  may  occur,  and  they  may  become  the 
carriers  of  intestinal  infections.  Outbreaks  of  typhoid  fever  have  been 
attributed  to  oysters  from  polluted  water. 

It  is  the  practice  in  some  sections  to  place  oysters  temporarily  in 
frrsh  water  shortly  before  putting  them  on  the  market,  with  a  view 
t<»  make  them  larger  by  reason  of  absorption  of  additional  water. 
This  process,  called  "fattening,"  i>  undesirable  in  that  it  lessens  the 
ivor  of  the  raw  oyster,  and  tends  toward  pollution  by  reason  of  the 


Mi 


156  NAVAL   HYGIENE 

fact  that  too  commonly  the  fattening  beds  are  in  small  streams,  the 
water  of  which  is  of  doubtful  purity. 

Oysters  purchased  in  bulk  for  ships  should  be  purchased  "dry,"  that 
is,  free  of  their  liquor.  This  fluid  may  well  be  supplied  in  a  separate 
container,  as  it  is  a  very  desirable  addition  to  oyster  stew  when  made  on 
a  large  scale. 

In  some  localities  the  oysters  possess  an  undesirable  flavor  owing 
either  to  mineral  or  organic  content  in  the  water  in  which  they  grow. 

During  the  summer  season  oysters  are  regarded  by  many  people 
as  unfit  for  food  during  the  months  the  names  of  which  do  not  include 
the  letter  "r."  While  the  absence  of  the  letter  "r"  from  the  name  of 
the  month  can  have  no  possible  connection  with  the  suitability  of 
oysters  for  food,  this  rule  is  not  a  bad  one,  because  it  is  particularly 
during  these  months  whose  names  do  not  include  "r"  that  intestinal 
diseases  are  most  prevalent,  oyster  beds  most  liable  to  pollution, 
and  in  addition  the  oyster  is  said  to  be  not  so  palatable  at  this  breeding 
season.  Oysters  never  should  be  eaten  raw. 

Clams,  when  they  are  available,  form  a  very  common  article 
of  diet  for  the  seafaring  man.  At  times  their  ingestion  results  in 
poisoning. 

The  following  entry  made  by  the  writer  in  the  Medical  Journal 
of  the  U.  S.  S.  Albatross  at  McHenry  Inlet,  Alaska,  September  12, 
1900,  is  of  interest  in  this  connection. 

An  abundance  of  clams  may  be  found  at  this  place.  Captain  J.  C.  Callbreath, 
proprietor  of  the  salmon  hatchery  here,  informed  us  that  they  are  excellent  and  are 
constantly  used  for  food  by  him  and  all  persons  at  his  hatchery.  As  Captain 
Callbreath  has  been  stationed  here  for  eight  years,  he  is  in  position  to  be  informed  on 
this  matter.  Upon  hearing  that  the  clams  were  innocuous,  all  the  messes  on  board 
secured  a  supply  of  them,  and  they  were  eaten  raw,  fried,  steamed,  in  chowder,  etc. 
Fourteen  persons  (one  officer,  three  petty  officers,  and  ten  of  other  ratings)  suffered 
to  a  greater  or  lesser  degree,  no  one  being  so  ill  as  to  be  wholly  excused  from  duty  for 
a  day.  The  two  pet  cats  also  suffered,  their  symptoms  being  very  severe.  The 
symptoms  commenced  to  manifest  themselves  within  three  hours  after  the  ingestion 
of  the  clams,  and  in  one  case  persisted  for  forty-eight  hours. 

Before  detailing  the  symptoms  it  may  be  of  interest  to  state  that  there  has  been 
no  change  in  the  water  supply,  and  the  messes  have  used  the  same  water  supply  for 
several  days.  There  has  been  no  change  in  diet  of  the  messes.  We  have  all,  of 
necessity,  been  on  sea  stores,  without  any  variation,  except  the  clams. 

Careful  examination  of  all  cooking  utensils  used  in  preparing  the  clams  for  the 
messes  showed  them  to  be  of  "granite,"  except  a  cast-iron  skillet.  No  vessel  was 
used  in  any  way  which  had  a  copper  bottom.  The  clams  were  carefully  cleaned  and 


FOOD 


157 


wen  cooked  within  twelve  hours  after  they  were  taken  from  the  beach.     The  toxic 
principle  exerted  its  greatest  effect  upon  the  nervous  system. 

The  following  symptoms  were  observed  and  may  be  thus  classified: 

I.  G  astro -intestinal: 

(a)  Cramps; 
(6)  Anorexia; 

(c)  Nausea; 

(d)  Vomiting; 

(e)  Tingling  of  oral  mucous  membrane; 
(/)    Perverted  taste; 

(g)  Swelled  tongue; 
(h)  Diarrhoea;  and 
(i)  Sense  of  mobility  and  decadence  of  the  teeth. 

(a)  The  cramps  were  not  severe,  but  were  an  almost  constant  symptom. 
They  were  chiefly  abdominal,  only  one  patient  complaining  of  slight 
cramping  in  the  extremities. 

(b)  Anorexia  was  a  constant  symptom. 

P(c)  Nausea  was  also  a  constant  symptom,  varying  in  intensity  from 
"squeamish"  feeling  or  "goneness"  to 
(d)   Vomiting,  which  was  prevalent  in  20  per  cent,  of  the  cases. 

(e)  Tingling  of  the  oral  mucous  membrane  was  present  in  every  case,  but 
not  anaesthesia. 

(f)  Perverted  taste  was  complained  of  by  most  of  the  patients. 

(g)  Four  patients  complained  of  swollen  tongue  with  tenderness.     Inspec- 
tion showed  no  perceptible  oedema,  and  this  symptom  is  believed  to  be 
one  of  several  nervous  disturbances  of  sensation  observed. 

irrhoea  was  observed  in  only  three  cases,  and  in  these  cases,  diar- 
rhceal  symptoms  were  not  severe. 

(*')  Sense  of  mobility  and  decadence  of  the  teeth  was  often  complained  of. 
The  feeling  was  described  as:  "My  teeth  feel  like  they  are  loose  and  are 
about  to  fall  out.  I  know  they  are  not,  but  they  feel  that  way." 
In  every  case  the  teeth  were  firm,  there  was  no  pain  upon  tapping 
upon  them  gently,  and  at  this  writing  no  other  symptom  has  appeared . 
-igns  of  inflammation  could  be  found  in  any  case. 

II.  Nervous  Symptoms : 

(a)  Motor: 

(b)  Sensory. 

(a)  The  motor  symptoms  were  as  foil" 

1.  MUM  ular  incoordination; 

2.  Muscular  weakness; 

3.  Paral . 

1 .  The  muscular  incoodination  was  observed  in  four  cases,  the  patients 
having  a  staggering  gait.     This  seemed  to  be  due  in  part  to  weak- 
ness  of  the  crural  extensor-.     The  foot  was  lifted  higher  from  the 
deck  than  normal. 

2.  Muscular  weakness  was  present  in  varying  degrees  of  intensity.     In 


158  NAVAL  HYGIENE 

several  cases  the  patients  were  unable  to  exert  force  to  a  painful 
extent  by  clasping  my  unresisting  palm  with  all  their  might. 
"Weak  knees"  were  observed,  and  a  constant  tendency  of  the  head 
to  fall  forward  was  complained  of. 

3.  Paralysis  is  mentioned  as  an  extreme  degree  of  depression  which 
may  occur  when  a  toxic  dose  of  the  poison  is  taken.  Both  cats 
above  mentioned  showed  motor,  but  not  sensory  paralysis  of  the 
hind  quarters,  and  in  attempting  to  walk  the  hind  legs  were  dragged 
along  as  inert  masses,  just  as  if  the  vertebral  column  were  fractured 
and  the  resulting  compression  of  the  spinal  cord  was  producing 
paresis.  One  man  had  a  dragging  gait  and  the  action  of  his  facial 
muscles  simulated  that  of  a  person  whose  face  has  been  benumbed 
by  prolonged  exposure  to  a  cold  wind. 

(b)  Sensory  symptoms  of  peculiar  and  diverse  character  were  observed  and 
were  as  follows : 

1.  Numbness; 

2.  Perversion  of  taste; 

3.  Loss  of  distance  perception; 

4.  Vertigo; 

5.  Sense  of  walking  up  hill  upon  walking; 

6.  Myalgic  pains; 

7.  Disturbance  of  tactile  perception;  and 

8.  Absence  of  anaesthesia. 

1.  Numbness  was  complained  of  in  every  case.     The  toxic  principle 
seemed  to  evince  selective  action  upon  the  sensory  fibers  of  the  fifth 
cranial,  or  the  trifacial  nerve.     In  every  case  the  patient  complained 
of  numbness  and  tingling  of  the  areas  corresponding  to  the  periph- 
eral  distribution   of    this  nerve.     In  some  cases   the  numbness 
extended  to  the  extremities,  and  in  these  cases  the  involvement  of 

l  the  fifth  cranial  nerve  seemed  to  be  exaggerated.  In  the  milder 
cases  the  fifth  nerve  alone  was  involved. 

2.  Perversion  of  taste  was  present.     This  was  most  probably  due  to 
the  above-mentioned  numbness. 

3.  Loss  of  distance  perception  was  an  interesting  phenomenon  ob- 
served only  in  one  case.     The  patient  was  a  strong  man  with  no 
apparent  predisposition  to  nervous  temperament,  or  disorder.     Ac- 
cording to  the  patient's  statement  which  is  accepted,  the  patient's 
perception  of  distance  was  almost  wholly  lost.     All  objects  seemed 
to  be  nearer  to  the  patient  than  they  actually  were.     He  would 
extend  his  hand  to  take  up  an  object,  only  to  realize  that  the  object 
was  not  within  his  reach.     This  condition  compelled  the  patient  to 
grope  about  as  though  he  were  blind.     Yet  he  could  see  every 
object.     In  descending  a  ladder  this  phenomenon  was  particularly 
noticeable. 

4.  Vertigo  was  present  in  varying  degrees  in  all  cases.     In  no  case 
was  subjective  vertigo  observed,  the  symptom  being  of  the  objec- 
tive type.. 


5.  Sense    of  walking   up    hill  was  noticed  in  several   cases.     The 
patients,  walking  upon  the  level  deck,  felt  as  if  they  were  walking 
up  an  ascent  or  sloping  floor.     This  sensation  caused  the  walking 
patient  to  lift  his  advancing  foot  from  the  deck  to  an  unusual 
height. 

6.  Myalgic  pains    were   present   in  four  cases.     The  patients  said 
their  muscles  were  sore,  as  if  they  had  been  beaten.     One  patient 
compared  the  myalgia  to  that  experienced  at  the  onset  of  influenza. 

7.  Disturbance  of  the  tactile  perception  was  observed  in  most  of  the 
cases.     I  believe  this  to  be  due  to  the  numbness.     Tactile  sensibil- 
ity was  very  much  obtunded. 

8.  Absence  of  local  anaesthesia  was  present  in  every  case.     Pain  could 
always  be  elicited  with  a  needle  point. 

III.  Heart  and  vascular  system  showed  no  changes  of  consequence.     In  the  cases 

presenting  marked  nervous  symptoms  I  fancied  that  I  could  detect  slight 
acceleration  of  the  heart's  action  and  a  correspondingly  slight  depression  in 
the  arterial  system.  Apparatus  for  the  detection  of  this  condition  was  not 
available  and  for  clinical  purposes  we  may  say  there  was  slight  depression, 
if  any  at  all. 

IV.  The  lungs  seemed  to  be  unaffected.     In  fact,  the  effect  of  the  toxic  principle 

upon  the  thermo-cardio-respiratory  tripod  may  be  said  to  be  negligible. 

V.  The  temperature  was  unmodified  so  far  as  could  be  observed.     Several  patients 

complained  of  warmth,  but  there  was  an  invariable  absence  of  pyrexia. 

VI.  The  skin  was  apparently  in  a  normal  condition  so  far  as  its  functions  are  con- 

cerned. Careful  search  failed  to  discover  any  erythema  or  eruption  of  any 
description.  One  patient  complained  of  formication.  Pallor  of  the  face  was 
observed  in  about  half  the  cases.  Diaphoresis  and  pruritus  were  present  in 
no  case.  Tingling,  numbness,  absence  of  local  anaesthesia  and  obtunding  of 
tactile  sensibility  have  been  commented  upon  in  describing  the  nervous 
phenomena. 

VII.  The  genito-urinary  system  presented  no  symptoms. 

VIII.  Audition  was  in  no  way  affected. 

IX  Except  as  noted  under  nervous  symptoms  vision  was  unmodified.  Pupillary 
symptoms  were  entirely  absent.  A  perhaps  noteworthy  symptom  was  the 
absence  of  anxiety  or  feeling  of  personal  insecurity.  No  patient  seemed 
mentally  depressed;  on  the  contrary,  the  patients  whose  nervous  systems 
showed  most  marked  symptoms  were  cheerful,  one  patient  jokingly  remark- 
ing: "This  is  a  capital  way  to  get  a  cheap  jag."  I  regret  that,  owing  to 
lack  of  facilities,  I  was  unable  to  test  the  nervous  and  muscular  reactions  to 
t-Urtrical  stimuli.  From  observation  of  these  cases  I  failed  to  note  a  differ- 
ence in  severity  of  the  symptoms  following  the  ingestion  of  raw  clams  from 
those  following  the  eating  of  cooked  clams. 
Ct-phalalgia,  chiefly  occipital,  was  a  constant  symptom. 

The  two  cats  were  affected  more  profoundly.  Vomiting,  cramping,  con- 
vulsions, etc.,  showed  serious  gastro-intestinal  involvement.  The  effect  of 
the  toxic  principle  upon  their  nervous  system  was  profound.  Staggering, 
weakness,  and  motor  paralysis  of  the  hind  quarters  were  observed.  Cardiac 


l6o  NAVAL   HYGIENE 

depression  was  present,  but  no  other  symptoms  were  observed.     It  is  interest- 
ing to  note  that  these  animals  ate  with  avidity  any  green  vegetable  matter 
offered  to  them.     This  may  have  been  due  to  thirst  on  their  part. 
Conclusions : 

I.  That  cramps,  anorexia,  nausea,  tingling  of  oral  mucous  membrane,  weakness, 
numbness,  obtunding  of  tactile  perception,  vertigo  and  cephalalgia  (chiefly  occipital) 
were  constant  symptoms. 

II.  That  the  toxic  principle  exercised  its  influence  chiefly  upon  the  nervous 
system. 

III.  That  the  sensory  nervous  system  was  most  affected. 

IV.  That  the  toxic  principle  seemed  to  possess  a  selective  action  upon  the  sen- 
sory fibers  of  the  fifth  cranial  nerve,  said  action  being  constantly  present  and  vary- 
ing in  intensity  directly  with  the  impression  of  the  poison  upon  the  general  nervous 
system. 

V.  That  the  motor  nervous  system  suffered,  but  less  constantly,  and  to  a  lesser 
degree  than  the  sensory. 

VI.  That  symptoms  of  gastro-intestinal  irritation  were  present  in  varying  degrees 
of  intensity,  apparently  bearing  no  definite  relation  to  the  severity  of  the  nervous 
symptoms. 

VII.  That  the  thermo-cardio-respiratory  relation  was  undisturbed. 

VIII.  That  no  effect  upon  the  genito-urinary  system  was  observed. 

IX.  That  about  25  per  cent,  of  the  persons  who  ate  clams  were  affected. 

X.  That  persons  who  ate  raw  clams  solely  and  those  who  ate  cooked  clams  solely 
were  affected  alike. 

XI.  That  analysis  of  the  drinking  water  on  this  vessel  fails  to  account  for  existing 
symptoms  in  those  affected. 

XII.  That  the  food  supply  of  the  three  messes  differs  in  no  way  from  what  it 
has  been  for  some  days,  except  as  to  the  addition  of  the  clams  as  an  article  of  diet. 

XIII.  That  members  of  three  messes  having  different  food  supplies  and  different 
cooking  facilities,  were  affected  similarly.     The  severer  cases  were  treated  with  full 
doses  of  strychnine  (sulphate)  with  excellent  results.     In  the  cases  presenting  mild 
symptoms  nothing  was  done,  except  to  watch  them  carefully  and  be  on  the  qui  vive 
for  the  development  of  graver  symptoms. 

These  very  interesting  cases  all  terminated  favorably,  even  the  cats  recovering, 
despite  the  severity  of  their  symptoms.  The  above  notes  have  been  carefully  made 
in  the  hope  that  they  may  prove  of  value. 

Facilities  were  not  available  for  bacteriological  examination  of  these  clams,  and 
it  is  not  known  whether  chemical  or  bacteriological  poisoning  was  the  cause. 


CHAPTER  XII 


PRACTICAL  INSPECTION  OF  FOOD 

Inspection  of  food  is  one  of  the  medical  officer's  most  important 
duties.  The  following  hints  are  given  to  the  inspecting  medical  officer, 
as.  they  have  been  found  of  value.  Chemical  analyses  are  omitted. 

Bread. — Bread  should  be  delivered  in  covered  containers  to  pro- 
tect it  from  dust,  moisture  and  insects. 
The  individual  loaves  should  be  wrapped. 
Contracts  for  bread  do  not  always  in- 
clude wrapping  of  the  individual  loaf. 
Consequently  there  is  a  greater  reason 
for  insisting  upon  delivery  in  covered 
containers.  Unless  the  medical  officer  is 
vigilant  the  bread  will  be  delivered  lying 
loose  on  the  bottom  of  a  dirty  wagon 
bed  and  carried  on  board  ship  by  sweaty 
arms  in  dirty  clothing.  The  loaves 
should  be  nicely  browned,  should  not  be 
scorched  and  they  should  be  carefully 
inspected  for  dirt  or  for  the  charred  re- 
mains of  previous  bakings  which  will  be 
found  baked  into  the  bottoms  of  the 
loaves. 

The  examiner  may  gain  information 
as  to  the  character  of  the  cooking  by 
compressing  the  loaf  gently  between  the 
hands.  It  should  be  resilient  and  not  Pic.  31— Careless  mess  cooks 
soggy.  Soggy  bread  should  be  rejected  T^y^l.  *  ""•"  °"  bare 
at  once  (a)  because  it  is  indigestible,  and 

(b)  because  it  is  an  inferior  article  which  weighs  more  than  good  bread. 
The  bread  should  be  sweet  to  taste  and  a  portion  of  it  taken  and 
relied  between  the  fingers  should  be  rolled  into  a  hard  ball  with  diffi- 
culty unless  the  loaf  is  slack  baked. 
11  161 


1 62  NAVAL  HYGIENE 

The  color  of  the  interior  of  the  loaf  should  be  normal  and  there 
should  be  an  absence  of  extraneous  matter  of  all  kinds;  for  instance, 
roaches,  weevil,  rat  faeces.  When  sliced,  the  bread  should  show  the 
normal  cellular  structure  characteristic  of  good  baking. 

Meat. — The  inspection  of  meat  requires  experience  and  should  be 
carefully  studied  by  the  medical  officer  who  has  the  interest  of  the  men 
at  heart. 

When  frozen  meat  is  being  delivered  the  same  number  of  hind  and 
fore  quarters  should  be  delivered  unless  the  contract  specifies  dif- 
ferently. The  meat  should  not  be  too  light,  nor  yet  too  dark  in  color, 
and  it  should  be  remembered  that  the  normal  color  of  beef,  pork  and 
mutton  is  very  different.  If  the  meat  is  too  dark  in  color  ante-mortem 
disease  may  be  suspected.  The  contracts  no  longer  call  for  veal. 
Excess  of  bone  should  not  be  accepted  and  the  examiner  also  should 
not  accept  meat  where  the  trimmings  will  amount  to  more  than  25 
per  cent,  of  available  meat. 

The  surface  of  the  meat  should  be  barely  moist  to  the  examining 
finger.  There 'should  be  no  weeping  from  a  greenish-grey,  foul-smelling 
surface.  The  meat  should  not  separate  from  the  bone  readily  and  a 
skewer  thrust  in  near  the  bone,  especially  in  the  pelvic  region,  will 
almost  always  reveal  a  foul  odor  in  decomposing  meat.  The  pleura 
should  be  free  of  adhesions.  There  should  be  no  evidence  of  disease. 
Stripped  pleura  suggests  tuberculosis. 

If  the  beef  is  frozen  it  should  be  delivered  in  burlap  and  should  be 
handled  in  a  cleanly  manner,  being  put  into  the  refrigerator  without 
having  opportunity  to  thaw. 

Fowls  should  be  examined  at  random  for  extra  weight.  Lead  or 
iron  slugs  have  been  put  into  the  cavities  of  dressed  fowls  in  order  to 
increase  their  weight.  The  odor  and  color  are  good  guides  to  the 
examiner. 

Fish. — See  page  154. 

Eggs. — Eggs  should  be  fresh  and  clean.  When  a  load  of  them 
is  being  examined  samples  should  be  taken  from  several  cases  and 
broken  into  a  bowl  to  determine  their  freshness.  The  medical  officer 
scarcely  will  have  experience  or  apparatus  for  candling;  however,  the 
old  egg,  because  of  evaporation  of  its  content,  will  give  a  sense  of 
rattling  within  the  shell  when  shaken  close  to  the  ear.  The  contents 
of  the  shell  will  make  a  noise  indicating  that  the  shell  is  not  full. 

Eggs  which  are  wet  or  soiled  should  not  be  accepted.     They  may 


PRACTICAL   INSPECTION   OF   FOOD 


I63 


be  infected.  The  shells  are  porous.  One  has  only  to  drop  an  egg  into 
a  solution  of  methylene  blue  and  allow  it  to  remain  for  a  brief  time  to 
see  how  easily  bacteria  in  solution  may  gain  entrance  to  the  interior 
of  the  egg.  Decomposing  eggs  will  float  in  water.  Good  eggs  sink. 


I' i«.    32. —  Mechanical  potato  i> 


ijreen    vegetables    and    fruits 
unwholesome  and   cannot  be 


Green  Vegetables.  Decomposing 
should  not  be  accepted  a>  they  are 
preserved. 

Potatoes.     The  examiner  should  make  due  allowance  for  a  small 

mage  of  mechanical  injuries  and  for  -mall  potatoes.     The  writer 

,ound  almo.-t   a  bushel  of  -mall  potatoes  and  dirt  in  a  barrel  of 

potatoes   which   a   dealer   was   trying   to   deliver.      Potatoes  less   than 


164  NAVAL   HYGIENE 

2  inches  in  diameter  should  not  be  accepted.  They  cannot  be  peeled 
readily  by  hand  nor  can  they  be  well  pared  by  the  mechanical  potato 
peeler.  Potatoes  which  show  a  large  percentage  of  decay  or  attack 
by  worms  should  be  rejected.  Large  potatoes  should  be  cut  in  halves 
at  random  as  they  frequently  are  diseased  and  have  large  cavities  on 
the  interior  surrounded  by  a  dark  area.  Potatoes  should  be  clean. 
Dirt  is  heavy.  It  makes  weight.  Potatoes  are  sold  by  the  pound. 

Sweet  Potatoes  or  Yams. — Sweet  potatoes  or  yams  should  be  of 
size  sufficiently  large  to  be  pared  properly  by  hand  and  should  not 
consist  of  nodular,  irregular  long  tubers  of  small  diameter  which  some- 
times are  delivered.  The  flesh  of  the  sweet  potato  should  be  almost 
white  to  yellow,  depending  upon  the  variety,  and  show  none  of  the 
black  mottling  characteristic  of  the  potato  which  has  been  frosted. 

Turnips,  carrots,  salsify,  parsnips  and  onions  should  be  delivered 
clean,  free  of  their  tops,  and  should  not  show  the  wrinkled  appearance 
characteristic  of  those  vegetables  when  they  have  been  long  out  of 
the  ground  and  have  dried  out.  The  examiner  should  not  insist  upon 
beets  being  delivered  washed  as  they  do  not  keep  well  after  being 
washed.  The  tops  should  be  cut  off  before  delivery. 

The  stems  of  rhubarb  should  be  delivered  free  from  the  leaves. 
Water  cress  should  not  be  accepted  on  board  as  a  salad.  Its  source 
is  too  questionable. 

Cabbage  and  Celery. — Cabbage  and  celery  should  be  of  good  quality 
and  fresh.  The  examiner  should  reject  celery,  cabbage  and  lettuce 
which  is  badly  blackened  by  mechanical  injury,  provided  such  black- 
ened portions  constitute  a  considerable  percentage  of  the  weight  of 
the  delivery. 

Fruit — Citrous  Fruit.- — Oranges,  grapefruit  and  lemons  should  show 
a  clear,  rounded,  succulent  oily  skin  which  should  not  be  too  thick. 
It  should  not  be  wrinkled  and  hard.  This  indicates  that  the  fruit  is 
old.  The  individual  pieces  should  be  heavy.  The  light  orange  or 
grapefruit  is  of  poor  quality  and  usually  dried  out,  yielding  little 
juice. 

Apples. — Sour  apples  should  not  be  accepted  if  it  can  be  avoided. 
They  will  not  be  eaten  and  require  too  much  sugar  in  their  cooking. 
They  should  be  fresh,  clean  and  not  dried  out,  as  will  be  indicated  by 
wrinkling  of  the  skin.  Imperfect  apples  should  not  be  accepted. 

Cheese. — Cheese  should  be  of  good  quality,  wholesome  in  appear- 
ance, and  delivered  in  closed  containers.  Canned  cheese  is  delivered 


PRACTICAL    INSPECTION    OF   FOOD  165 

from  time  to  time  which  has  undergone  butyric  acid  fermentation  on 
its  exterior.  It  is  very  foul  smelling,  mushy,  and  appears  to  be  un- 
wholesome, but  if  this  exterior  layer  be  removed  wholesome  cheese  will 
be  uncovered.  If  the  cheese  is  black  on  the  outside,  and  particularly 
if  there  is  roughness  of  the  interior  of  the  can,  indicating  that  the  metal 
has  been  attacked,  the  cheese  is  unfit  for  consumption. 

Butter. — Butter  is  usually  delivered  in  tubs  and  should  be  of  good 
color,  not  rancid,  and  fresh  to  smell  and  taste.     At  times  butter  is 
worked  over  by  the  dealers  and  contains  a  large  amount  of  water. 
Tliis  of  course  adds  to  weight,  butter  being  sold  by  the 
pound.     This    water    is  contained  in  cavities  in  the 
bitter  which  may  not  be  apparent  from  the  surface. 
It  is  easy  to  make  the  surface  appear  homogenous  by 
the  local  application  of  heat. 

The  only  way  that  a  tub  of  butter  can  be  examined 
in  the  hurried  inspection  which  is  practicable  is  by 
the  aid  of  a  trier.  The  long  cylinder  of  butter  Te- 
rn >ved  by  this  instrument  will  cut  through  the  cavi- 
ties and  excess  of  water  will  be  immediately  apparent. 
Further,  the  cylinder  of  butter  may  be  examined  as 
to  color  and  quality.  Rancid  butter  at  the  bottom  of 
the  tub  thus  may  be  detected,  even  when  covered  by 
fresh  butter. 

Milk. — The  practical  inspection  of  milk  upon  de- 
livery is  almost  wholly  limited  to  seeing  that  the  milk 
comes  from  approved  contractors  whose  establishments 
are  known  to  be  properly  controlled  by  the  health 

authorities  and  that  it  is  delivered  in  a  clean  manner 

FIG.  33.— 
!  surrounded  by  ice.  The  butter  trier; 

The    bacteriological    examination  requires  time  as  an  invaluable  aid 
dues  the  cell  count.     These  are  impracticable  as  they  tab^of  Gutter?8 

ite  delay  to  the  delivery  wagon.     The  examination 
to   the   method   of  delivery  and  the  taking  of   the  specific  gravity 
are   as   much  M   be   done.     All    milk   brought  on    board    ship 

>uld  be  pasteuri/ed  or  boiled. 

Biscuit.-   When    packages   of    biscuit    are    brought    on    board    the 
parc.vls   should   !•<  !  at  random  and  opened  t<>  be  examined  for 

evil. 


i66 


NAVAL   HYGIENE 


The  Bum  Boat. — While  the  bum  boat  is  prohibited  by  regulation 
in  the  fleet,  when  ships  are  at  navy  yards,  certain  small  dealers  in  food 
stuffs,  principally  confectionery  and  milk,  have  permits  to  sell  within 
the  limits  of  the  naval  station  and  frequently  station  themselves  and 
their  wares  at  the  brow  on  the  dock. 

Unless  these  small  dealers  are  kept  under  close  supervision  they 
may  be  very  filthy  in  their  handling  of  foods  and  may  spread  disease. 
The  boxes  in  which  their  wares  are  contained  have  been  found  extremely 
filthy.  The  pies  and  cakes  often  are  left  exposed  on  boards  to  be  soiled 


FIG.  34. — Bum  boats — small   boats  in   which   petty   dealers   bring  their   wares 

alongside  for  sale. 

by  insects  and  the  clouds  of  dust  that  often  are  blown  down  the  dock. 
Milk  is  allowed  to  stand  in  bottles  in  the  sun,  and  the  average  of  these 
dealers  appears  to  have  little  interest  other  than  the  collection  of  the 
money  for  poorly  handled  or  dirty  food.  The  medical  officer  should 
have  these  wares  inspected  or  should  inspect  them  personally  himself 
daily  before  permission  is  given  for  men  to  buy.  If  the  confectionery 
is  handled  in  a  dirty  manner,  is  not  properly  covered  or  of  poor  quality 
the  medical  officer  should  unhesitatingly  deny  the  privilege  to  sell  to 
the  ship.  After  one  or  two  rejections  of  this  character  the  dealers 
usually  will  handle  the  food  properly.  The  medical  officer  should 
assure  himself  that  milk  is  delivered  properly  iced,  and  that  the  dates 


PRACTICAL   INSPECTION   OF   FOOD 


I67 


or  the  caps  of  the  bottles  show  that  the  milk  has  been  bottled  within 
twenty-four  hours.  Often  the  bottles  will  have  a  collection  of  water 
aid  dirt  on.  top  of  the  paste-board  cap.  The  dealers  should  be  cau- 
tioned to  ice  the  milk  in  such  a  way  that  this  cap  will  not  be  fouled 
aid  that  polluted  water  may  not  enter  the  bottle  when  the  cap  is 
withdrawn. 


CHAPTER  XIII 
CLOTHING 

Clothing  is  material  used  by  man  to  protect  his  skin  from  trauma, 
heat,  or  cold,  and  to  adorn  or  conceal  his  person. 

These  materials  are  derived  from  the  Animal  and  Vegetable  King- 
doms: 

From  the  Animal  Kingdom: 

Silk; 
Wool; 
Leather; 
Fur. 

From  the  Vegetable  Kingdom: 

Cotton; 

Linen; 

Other  fibers  and  papers. 

The  above  are  the  common  sources  for  man's  clothing  of  animal  and 
vegetable  origin,  but  by  no  means  embrace  all  sources  from  which  man 
obtains  his  artificial  covering. 

FROM  THE  ANIMAL  KINGDOM 

Silk  is  made  from  the  fibers  of  the  cocoon  of  Bombyx  mori  and  other 
kinds  of  bombyx  or  silk  spinners.  The  fibers  are  cylindrical,  smooth, 
and  under  the  microscope  present  neither  joints  nor  imbrications. 
They  are  yellow  in  color  in  the  raw  state. 

Wool  fiber  is  obtained  from  the  hair  of  many  animals,  sheep,  goats, 
alpaca,  camel,  etc. 

Under  the  microscope  the  wool  fiber  presents  characteristic  imbri- 
cations, the  scales  of  the  hair  overlapping  each  other  like  the  shingles 
on  a  roof,  giving  the  wool  fiber  an  unmistakable  appearance.  This 
fiber  is  considerably  larger  than  the  silk  fiber. 

168 


CLOTHING 


169 


Leather  is  the  skin  of  animals  appropriately  treated  or  dressed. 
Fur  is  the  skin  of  fur-bearing  animals. 

FROM  THE  VEGETABLE  KINGDOM 

Numerous  plant  fibers  are  used  in  various  parts  of  the  world.     We 
shall  concern  ourselves  with  cotton  and  linen. 


Wool 


SilK 


Linen 


I- 1'.    35  -ilk  and  !  :\  from  microscope  prep- 

;ons. 

Cotton.  This  is  the  seed  hair  from  the  cotton  plant,  and  is  ordi- 
narily 15  t«.  20  microns  thick.  The  fibers  are  spirally  twisted  on  their 
loni:  axi-  as  viewed  under  the  microscope,  and  present  a  reniform  or 
flat  transverse  section.  The  surface  of  the  fiber  is  rough. 


170  NAVAL  HYGIENE 

Linen  comes  from  flax  and  in  its  prepared  state  is  a  somewhat  round 
fiber  12  to  26  microns  long  and  showing  transverse  and  longitudinal 
fissures.  Usually  there  is  little  difficulty  in  identifying  these  fibers 
under  the  microscope,  but  when  a  microscope  is  not  available  the 
following  simple  tests  may  be  made: 

1.  Burning. — Wool  and  silk  give  off  an  empyreumatic  odor  like 
burned  horn,  whereas  linen  and  cotton  give  odor  as  of  burning  paper. 

2.  Wool  and  silk  burn  poorly  while  linen  and  cotton  burn  readily. 

3.  Wool  is  very  slightly  soluble  in  10  per  cent,  hot  potassium  hydrate 
solution,  while  silk  dissolves  readily.     Cotton  and  linen  are  unaffected. 

4.  Cold  sulphuric  acid  readily  dissolves  silk,  cotton  and  linen,  but 
slowly  dissolves  wool. 

Any  of  the  above-mentioned  fibers  when  woven  into  cloth,  or  when 
mixtures  of  the  above  are  woven  into  cloth,  form  the  fabric  of  which 
garments  are  made. 

Clothing  affords  protection  against  cold  by  means  of  imprisoning 
a  warm  layer  of  air,  which  is  the  poorest  of  conductors  of  heat,  between 
the  body  and  the  garments;  consequently  a  loose  garment  is  warmer 
than  one  of  the  same  material  and  weight  which  fits  tightly,  e.g.,  Chinese 
clothing,  and  also  several  layers  of  clothing,  by  virtue  of  their  subjacent 
and  confined  air  layers,  are  warmer  than  one  layer  of  the  same  material 
and  weight. 

The  average  temperature  of  our  climate  is  far  below  the  specific  heat 
of  man,  consequently  the  organism  must  maintain  combustion  processes 
for  liberation  of  heat.  The  higher  the  amount  of  heat  given  off,  the 
more  must  the  body  be  heated — this  means  the  greater  must  be  the 
ingestion  of  food  materials  and  protection  of  the  body  with  additional 
clothing.  Hence  the  wearing  of  clothing  has  an  actual  bearing  upon 
required  amount  of  food,  the  necessity  under  given  conditions  being 
greater  or  less,  depending  upon  the  extent  to  which  clothing  prevents 
the  escape  of  body  heat. 

Again  clothing  renders  more  easy  the  giving  off  of  heat  from  the  body 
if,  as  result  of  physical  exercise  or  of  excessive  ingestion  of  foods,  much 
heat  is  generated,  and  especially  if  in  addition  the  atmospheric  tempera- 
ture of  our  warm  season  renders  more  difficult  the  cooling  of  the  body. 

Body  heat  is  lost  through: 

(a)  Radiation; 

(b)  Conduction; 

(c)  Evaporation. 


I  CLOTHING  171 

(a)  Radiation. — At  room  temperature  of  i5°C.,  if  the  radiation  from 
the  nude  skin  be  placed  at  100  per  cent., 

Clothing  with  wool  shirt  allows  a  radiation  =  73  per  cent. 
Clothing  with  linen  shirt  and  wool  shirt 

allows  a  radiation =  60  per  cent. 

Clothing  with  wool  shirt,  linen  shirt,  vest 

and  coat  allows  a  radiation =  33  per  cent. 

A  fully  dressed  man  loses  through  radiation  only  one-third  of  the 
heat  he  would  give  off  if  his  body  were  nude. 

(b)  Conduction. — Originally  it  was  believed  that  the  heat  conduc- 
tion of  a  given  material  was  dependent  upon  thickness  of  material 
employed.  Rubner's  researches  have  shown  that  various  clothing 
materials  possess  very  different  powers  of  heat  conduction. 


The  ah 


Placing  conduction  of  air  at  unity  =  i 
The  conduction  of  hair  of  animals  =  9 
The  conduction  of  silk  =  16.  7 

The  conduction  of  plant  fibers         =  16.  7 

above  figures  refer  to  the  dry  material.  When  wet,  these 
material  act  differently,  and 

(c)  Evaporation  comes  into  play. 

Clothing  materials  capable  of  water  absorption  hold  water  either 
from  the  body  or  without  in  two  ways: 

1.  By  actual  hygroscopicity,  in  which  the  basic  fibers  absorb  water 
and  swell,  tending  to  reduce  the  size  of  mesh  in  the  cloth.     Animal 
fiber  possesses  this  to  greater  degree  than  plant  fiber. 

2.  By  water  of  interposition,  which  is  not  absorbed  by  the  fibers,  but 
merely  lies  around  them  in  minute  drops,  and  occludes  the  air  spaces 
or  me>hes  between  the  fibers.     The  quantity  of  water  of  interposition 
is  more  dependent  upon  the  weave  than  upon  the  fiber,  and  can  be 
wrung  or  pressed  out.     Not  so  with  icater  of  hygroscopicity. 

Man  finds  that  material  most  comfortable  which  absorbs  water  with 
difficulty  and  gives  it  off  slowly.  It  is  highly  desirable  that  the  mate- 
rial shall  not  lo>e  greatly  its  essential  elasticity,  but  shall  stand  out 
from  tin  body  -urface,  allowing  an  air  layer  to  IK-  interposed,  rather 
than  that  the  moist  fabric  shall  lie  wet  upon  the  body  surface.  Air 
conducts  heat  only  one  twenty-eighth  so  rapidly  as  water.  Close 
approximation  to  body  surface  prevents  proper  evaporation  from  skin 


172  NAVAL  HYGIENE 

and  proper  excretion  of  carbon  dioxide  from  skin  surface,  causing  loss 
of  heat  in  winter  and  retention  of  heat  (prevents  evaporation)  in 
summer. 

This  produces  discomfort  by  reason  of  improper  hindrance  of  radia- 
tion, as  is  experienced  when  wearing  rubber  coats  or  other  air-tight 
garments. 

Wool  appears  to  be  the  only  fabric  which  when  saturated  still  per- 
mits passage  of  air  through  its  substance  and  should  be  loosely  woven. 
Many  cannot  wear  wool  next  to  the  skin  because  of  disagreeable  sense 
of  irritation  of  the  surface.  It  tends  to  absorb  odors.  Again,  wool 
shrinks  if  carelessly  washed  in  hot  water,  is  relatively  expensive,  and  is 
more  quickly  worn  out. 

Despite  the  above-enumerated  objections,  wool  is  most  desirable, 
because  it  best  corresponds  to  the  requirements  of  hygiene. 

As  between  linen  and  cotton  fabrics  linen  is  smoother,  brighter, 
stronger,  more  durable,  irritates  the  skin  less,  and  by  virtue  of  the 
smoothness  of  its  fibers  retains  dust  and  bacteria  upon  its  surfaces 
to  less  degree  than  cotton.  For  underwear  linen  is  smoother,  cleaner, 
cooler,  permits  more  ready  evaporation  of  perspiration,  and  absorbs 
perspiration  more  readily.  Hence  gives  more  general  comfort  to  the 
wearer. 

The  color  of  clothing  exercises  a  very  marked  influence  upon  heat 
absorption,  white  being  least,  and  black  or  dark  blue  most  absorptive. 

Coullier  found  that  a  thin  cotton  cloth  laid  over  dark  woolen  cloth 
in  sunshine  reduced  the  temperature  of  the  woolen  cloth  i2.6°F. 

Since  white  absorbs  less  heat  than  any  color  it  is  most  generally 
worn  in  hot  climates.  Despite  this  quality,  its  conspicuousness  and 
the  difficulty  of  keeping  it  clean  render  it  unsuitable  for  use  for  the 
navy  afloat  or  ashore,  yet  it  is  the  prescribed  color  for  summer  uniform. 

For  military  reasons  it  is  desirable  to  have  the  uniform  of  a  body 
of  men  as  inconspicuous  as  possible,  so  that  they  may  not  be  recognized 
in  the  distance  because  of  color  of  clothing,  and  also  because  it  is 
undesirable  to  offer  a  good  target  to  the  enemy. 

In  the  day  white  is  most  conspicuous  in  the  distance,  dark  blue 
and  scarlet  next.  Least  easily  recognized  in  average  circumstances 
is  perhaps  "khaki,"  which  is  used  by  our  troops  (Army  and  Marines), 
in  summer  or  warm  weather.  The  olive  drab  uniforms  worn  by 
the  Army  are  equally  protective.  Mosquitoes  are  not  attractec'.  by 
khaki  color. 


CLOTHING 


173 


If  clothing  is  to  be  used  to  protect  against  heat,  then  we  should 
choose  the  colors  which  reflect  a  maximum  of  heat  rays  and  absorb 
a  minimum.  If  we  place  the  absorption  of  heat  rays  by  white  fabric 
at  100,  then 

Khaki  =  102 

Dark  yellow  =140 


Light  green 
Dark  green 
Bright  red 
Light  blue 
Black 


=  155 

=  169 

=  165 
=  199 
=  208 


Tlu-se  are  their 
trunks.     They  make  an  excellent  container  for  their  clothing. 

ARTICLES  OF  CL<>HII\<, 

The  clothing  of  the  enlisted  personnel  in  the  lower  ratings  is 
>lU'd.  stopped,  mid  neatly  stowed  in  canvas  bags.  These  bags  are 
Lslu-d  to  an  iron  rail  or  "bag  netting.' 

The  underclothing  of  the  Navy  consists  of  light  nainsook  short- 


174 


NAVAL   HYGIENE 


sleeved  undershirts  and  running  drawers  for  warm  weather.  Light-weight 
cotton  shirts  and  long  drawers  also  are  provided  for  summer  wear. 

In  winter  heavy  woolen  underwear  is  provided.  This  fabric 
contains  an  admixture  of  cotton.  The  underwear  is  in  two-piece 
suits:  shirt  and  drawers. 


FIG.  37. — Short-sleeved  undershirts  worn  in  warm  weather. 

For  outer  clothing  in  warm  weather  the  officers'  uniforms  are  made 
from  cotton  r  inen  duck.  Those  of  the  enlisted  men  are  made  of 
cotton  drill.  These  are  two-piece  suits,  and  consist  of  blouse  or 
"jumper"  and  trousers. 


CLOTHING 


175 


;8. —  Blue    blou.v  -mifcrni    worn    by   commissioned   and   warrant 

'.-.form  Regulations.) 


NAVAL  HYGIENE 


FIG.  39. — White  service  uniform  worn  by  commissioned  and  warrant  officers  in 
warm  weather.     (Uniform  Regulations.} 


CLOTHING 


In  cold  weather  navy  blue  cloth  or  serge  is  used  for  outer  clothing, 

ie   till    of   the  clothing  (It-pending  upon   whether  it  is  intended   for 
ilisted  men,  chief  petty  officers,  or  officers  of  the  warrant  and  com- 

•ned  grades. 

The  blouse  worn  by  the  commissioned  and  warrant  cfficers, 
,-hether  made  of  cloth  or  white  duck,  fastens  closely  at  the  neck  and 
high  standing  collar.  While  this  feature  is  desirable  in  winter,  in 
ummer  the  collar  about  the  neck  is  uncomfortable.  This  blouse 
ermits  less  freedom  of  action  than  the  double-breasted  reefer  coat 
rorn  in  other  navies. 

When  well  made  the  blouse  of  the  American  naval  officer  is  distinc- 
ive  and  its  disadvantages  are  so  few  that  its  continued  use  is  desirable. 
~he  coat  worn  by  the  chief  petty  officers  is  a  double-breasted  reefer 
oat  made  of  cloth,  serge,  white  duck,  or  drilling,  as  may  be  indicated. 
his  wide  open,  "V-shaped  collar  necessitates  the  wearing  of  shirts, 
(iff  collars,  and  ties.  In  summer  it  is  difficult  for  chief  petty  officers 
carry  a  supply  of  linen  sufficiently  great  to  appear  neat  at  all  times. 
tunic  fastening  at  the  neck  would  permit  the  wearer  to  lay  aside 
ollar,  tie,  and  shirt,  with  corresponding  increase  in  comfort,  conven- 
:nce,  and  improvement  in  appearance. 

The  outer  clothing  of  enlisted  men  below  the  grade  of  chief  petty 
icer  consists  in  juniper  and  trousers  made  of  white  drilling.     These 
•e  loose  and   permit   a  maximum  of  freedom  of  action.     Since  the 
•  hite  jumper  falls  loosely  over  the  trousers  at  the  waist  band  and  is 
m  at  the  neck  and  sleeves,  free  circulation  of  air  is  facilitated.     The 
diite  color  and  the  free  circulation  of  air  under  the  jumper  make 
a  comfortable  garment  for  wear  in  warm  weather. 
While   white  clothing  has  many  advantages  it  possesses  the  dis- 
.'IvuntagL-s    of    being    too    conspicuous    and    easily    soiled,    especially 
ftihore. 

At  \Yra  Cruz  abundant  opportunity  was  afforded  to  see  the  pitiable 
unsuitability  of  white  uniform-  for  service  a-hore.  To  render  them- 
Mdves  Less  conspicuous  to  the  bulU-ts  of  snipers,  improvised  dye--. 
drenching  with  coffee,  and  actual  wallowing  in  mud  were  resorted 
to  by  men  who  realized  the  danger  to  which  a  white  uniform  exposed 
them. 

Khaki,  olive-drub  or  slute-colored,  easily  wushuble  cotton  uniform, 
\\ould  prove  more  serviceable  and  more  nearly  meet  all  the  requirements 
rvice  for  both  officers  and  enlisted  personnel. 


i78 


NAVAL  HYGIENE 


FIG.  40. — Blue  service  uniform  worn  by  chief  petty  officers  (on  the  left). 
the  right  is  a  bluejacket  in  service  blue.     (Uniform  Regulations.) 


On 


CLOTHING 


f  enlisted  men.     A  chief  petty  officer  on  the  right. 
(Uniform  Regulations.) 


180  NAVAL  HYGIENE 

For  working  parties  and  in  the  engine  room  blue  dungarees  are 
used. 

In  cold  weather  the  enlisted  personnel  below  the  grade  of  chief 
petty  officer  wear  a  suit  made  of  navy  blue  cloth  or  serge  and  cut 
after  the  pattern  so  commonly  know  as  a  "  sailor  suit. "  This  consists 
of  a  loose  blouse  having  a  wide  sailor  collar  and  sleeves  having  wrist 
bands  which  button  tightly  at  the  wrist,  thus  confining  some  of  the 
warm  air  heated  by  the  body.  The  large  opening  at  the  neck,  however, 
permits  the  escape  of  the  air,  and  unless  very  heavy  undershirts  and 
sweaters  are  worn,  the  sailor's  blouse  is  apt  to  be  a  very  cool  garment. 
It  is  loose  and  permits  utmost  freedom  of  action  for  the  wearer.  The 
trousers  are  cut  after  the  pattern  of  the  old-fashioned  barn-door 
trousers  which  were  discarded  generations  ago  in  the  general  interest 
of  efficiency.  The  legs  of  the  trousers  are  very  loose  and  have  a  marked 
swell  at  the  bottom,  enabling  them  to  be  rolled  up  easily  when  necessary 
for  wading.  These  trousers  have  a  lacing  at  the  back  of  the  waist 
and  fit  very  snugly,  being  worn  without  suspenders.  The  writer  is  of 
opinion  that  this  feature  is  a  considerable  factor  in  the  production 
of  the  hernias  which  are  so  much  seen  in  the  service. 

The  pea  coat  used  by  the  enlisted  men  is  a  short,  double-breasted 
reefer  coat  buttoning  closely  at  the  throat,  is  made  of  heavy  dark 
blue  cloth,  and  while  reasonably  warm  affords  little  protection  to  the 
lower  extremities.  Its  collar  is  wide  and  when  turned- up  gives  pro- 
tection to  the  neck. 

The  overcoat  worn  by  commissioned  and  warrant  grades  is  a 
Jong,  double-breasted  coat  made  of  heavy  pilot  cloth  which  extends 
well  below  the  knees  and  fastens  closely  at  the  throat.  It  has  a  slit 
over  the  left  hip  to  permit  the  wearing  of  the  sword. 

For  officers  a  long,  heavy  cloth  cape  or  "boat  cloak"  is  provided. 
This  cape  falls  below  the  knees  ar>d  is  a  very  serviceable  garment, 
especially  for  wear  in  boats,  as  in  the  case  of  accident  the  wearer  may 
release  himself  from  it  quickly  and  commence  swimming.  The  heavy 
overcoat  could  not  be  readily  discarded  by  the  wearer  in  the  water. 

Head-gear. — Commissioned,  warrant,  and  chief  petty  officers 
wtar  cloth  caps  with  visors  projecting  over  the  eyes  at  an  angle  of  about 
40  degrees.  The  visors  are  of  dark  leather  and  offer  some  protection 
to  the  eyes  in  bright  sunlight.  These  caps  afford  no  protection  to  the 
back  of  the  neck  in  falling  weather  or  under  a  hot  sun. 


CLOTHING 


\2. — Blucj  coat  and  overcoat  respec- 

tiv  Buttons.) 


182 


NAVAL   HYGIENE 


FIG.  43- — Overcoat  and  boat  cloak  worn  by  commissioned  officers.      (Uniform 

Regulations.) 


CLOTHING 


For  wear  in  hot  weather  a  cap  of  similar  shape,  having  a  removable 
lite  duck  or  drilling  cover,  is  substituted  for  the  cloth  cap. 
A  cork  or  pith  helmet  with  visor  extending  well  backward  over  the 
k  is  desirable  for  those  who  must  stand  watch  under  a  tropical  sun. 


ally,  or  nearly  so,  the  back  of  the 
•icek  receives  almost  no  protection. 

The  bluejacket-  wear  a  tlat  sailor  hat  made  of  cloth.     A  removable 
iteel  gromnu'l  is  worn  within  the  cap  and  serves  to  produce  the  disk- 

•iaped  rap,  known  as  a  sailor's  cap.      In  windy  weather  the  tlat  cap 
easily  blown  off;  consequently  the  grommet 
often    removed    and    the    hat    is    converted 
to  an  inverted  bag  on  the  sailor's  head. 
The    tlat    hat    is   peculiarly  ill  adapted  for 
purpose.      It    afford-^    little    protection    to 
wearer    from    sun   or   rain   and    blows   otT 
;ily.      A    "watch    cap"  of  knitted  blue  yarn 
much  worn   by  the  men  on  deck  in  cold  or 
idy  weather. 

The  white  hat    worn    by   the   bluejacket    is 

,        e  ii-i  i  •          i   •,,.  -Unsh  aded 

era!    thicknesses  ol    white    drilling   ;i,(  ,  Indicates  unprotected 

!ched     together,    forming     a     -kull    cap    to   ***** 

...  ,       ,  i     •  r      i  -".ost  superficial. 

uch  i>  attached  a   brim  of  the  same  ma- 

•ial,    heavier,    and     -tiffened    bv   close   stiichini;.     This   brim    when 
i  down  over  the  eyes  afford-  a  little  proU-ctimi.  and  if  the  brim 
>e   turned    down  at    the  back,  considerably    more  protection   is  given 
in  by  the  tlat  hat  above-  mentioned. 


184  NAVAL  HYGIENE 

The  writer  thinks  that  if  the  brim  of  this  hat  were  widened  poste- 
riorly, giving  it  somewhat  the  shape  of  a  "southwester,"  that  it  would 
afford  much  more  protection. 

Green  leaves  or  a  wet  handkerchief  should  be  worn  under  this  white 
hat  in  a  hot  sun,  or  else  the  hat  itself  should  be  wet.  A  hat  shaped 
like  the  "south wester''  and  wet  would  afford  considerable  protection 
to  the  back  of  the  neck. 

Rain  Clothes. — For  officers  and  men  standing  watch,  oil  skins 
are  used  as  rain  clothes.  These  consist  of  a  thoroughly  oiled  water- 


FIG.  46. — The  white  service  hat  now  in  use  (brim  turned  down).  On  the  right 
i  s  a  sketch  of  a  cloth  hat  suggested  by  the  author.  The  brim  should  be  stiffened  by 
stitching. 

proof  coat,  buttoning  closely  at  the  neck,  and  water-proof  trousers 
of  the  same  material  which  come  down  over  the  tops  of  rubber  boots. 
Sometimes  long  oil-skin  coats  are  worn  without  trousers.  These 
coats  come  down  below  the  tops  of  the  boots.  "South westers"  are 
worn  by  officers  and  men  as  head-gear  in  falling  weather. 

A  black  mackintosh  coat  with  cape  attached  is  prescribed  for  all 
commissioned  officers  for  wear  in  rainy  weather,  and  a  cap  cover  made 
of  oil  cloth  is  worn. 

Foot-gear. — In  wet  weather  rubber  boots  and  rubber  hip  boots  are 
worn. 

In  summer  with  white  uniforms  white  canvas  shoes  are  prescribed 
for  the  officers. 

The  enlisted  men  wear,  summer  and  winter,  high  black  leather 
shoes  of  the  Blucher  pattern  having  a  cap  at  the  toe,  broad  low  heel, 


; ;.  -Rain  nlistcd   men.      As  stated  in  the  text,  these  are 

worn  by  the  commissioned  officers  frequently  in  preference  to  the  mackintosh 
(Uniform  Regulations.) 


i86 


NAVAL   HYGIENE 


FIG.  48. — A  skiagram  showing  a  foot  deformed  by  wearing  shoes  too  narrow  at 
the  toe.  The  great  toe  is  bent  toward  the  mid-line  of  the  foot.  The  other  toes  are 
deformed,  the  outer  three  are  also  turned  toward  the  mid-line  and  overlap  each 
other.  This  deformed  foot  was  X-rayed  in  a  shoe  having  a  pointed  toe. 


FIG.  49. — Skiagram  of  foot  deformed  by  wearing  shoes  having  point 
The  great  toe  is  bent  toward  the  mid-line  of  the  foot,     The  second  toe  is  a  hammer 
toe.     The  other  toes  are  deformed  and  overlap.     (X-rayed  in  the  shoe.} 


CLOTHING  187 


thick  soles  and  a  wide  toe  to  enable  the  spread  of  the  foot.  Shoes 
should  be  abundantly  wide,  for  the  foot  spreads  a  half-inch  in  width 
when  the  individual  rises  and  is  carrying  a  weight  equivalent  to  that 
of  a  bluejacket's  accoutrements  when  he  is  in  heavy  marching  order. 
Tin-  individual  should  be  required  to  stand  on  one  foot  and  sustain  a 
weight  of  40  pounds  while  being  fitted.  This  produces  maximum 
spread  of  the  foot.  As  the  average  of  enlisted  men  are  vain  about 
aji Durance  °f  tnen"  ^eet  tnev  ten^  to  select  shoes  too  small  for  them- 

es.     The  company  officers  should  be  required  to  fit  the  men  with 

-  to  insure  that  they  are  properly  fitted. 

Socks. — Socks  are  of  cotton  or  wool  and  should  be  free  of  holes. 

I/  should  not  be  so  large  as  to  enable  the  formation  of  creases  which 
to  produce  blisters. 


EXTRA  HEAVY  CLOTHING 


For  service-  in  the  very  cold  climates  the  following  clothing  has  been 
supplied  to  the  naval  service  and  may  be  worn  either  by  officers  or 
erlisted  men: 

Long,  heavy  merino  drawers  and  extra  heavy  long-sleeved  under- 
shirts of  tin  same  material  are  provided.  These  undershirts  are  rein- 
'1  front  and  bark  by  a  second  layer  of  the  same  material.  The 
front  and  bark  pieces  are  sewed  on  to  the  shirt  and  form  a  double  thick- 
ru  ss  from  tin-  neck  to  the  waist.  The  neck  band  is  made  to  fit  snugly 

«to   retain    the  layer  of   warm  air  under  the  shirt. 
The  socks  are  made  of  extra  heavy  wool  and  afford  splendid  pro- 
ction  to  the  feet.     They  are  intended  to  be  worn  over  lighter  cotton 
or  \\oolen  -oiks.     The  boots  are  high  leather  boots,  having  a  sole  at 
least    '  •_>  inch  thick.     The  uppers  are  sewed  to  the  leg  of  the  boot 
by  three  row<  of  strung  pitching,  and  a  row  of  similar  stitching  binds 
the  counter  to  the  upper.     These  leather  boots  extend  to  the  knee  and 
^ifficiently  large  to  contain  the  lower  ends  of  the  trouser  legs. 
•  wet  or  snowy  weather  a  high  arctic  overshoe  or  boot  is  provided, 
coated   with   rubber.      The  seams  are    well   sowed   and   the  boots 
laced  by  mean-  of  eight   eyeleN  on  each  side  of  the  long  tongue, 
ch  i-  fa-'ened  to  the  side*;  by  water-proof  seams  and  cement.     The 
f  \\r,<  boot  i<  large  enough  to  include  the  lower  ends  of  the  trouser 
lej-  oi  ;ho  wearer.      The  tongue  i-  reinforced  at  the  bend  of  the  ankle 

K;>iece  of  rubber  which   is  cemented  on   to   the  front   of  it.      This 
t  i>  large  enough  to  be  worn  over  the  shoes. 


i88 


NAVAL   HYGIENE 


The  hands  are  protected  by  heavy  mittens  made  of  blanket  material 
ribbed  at  the  wrists  to  protect  them. 

The  blue  trousers  and  jumper  are  worn  with  or  without  a  pea-coat. 
Over  this  is  worn  an  overshirt  made  of  heavy  woolen  material,  having 
a  hood  continuous  with  the  neck.  This  overshirt  has  no  buttons,  but 
is  slipped  on  and  the  opening  at  the  neck  is  laced  so  that  the  hood 
covers  the  entire  head  except  the  face.  This  overshirt  extends  almost 
down  to  the  knees. 


FIG.   50. — Heavy  rubber  arctic  overshoe.      Note  the  reinforcement  in  front  at 
the  bend  of  the  ankle. 


For  wear  in  wet  weather  a  mackintosh  suit  consisting  of  jumper  and 
trousers  is  provided.  The  jumper  slips  on  over  the  head,  and  the 
opening  at  the  neck  is  closed  by  two  flaps,  the  outer  overlapping  the 
inner  and  serving  the  double  purpose  of  reinforcing  the  mackintosh 
layer  over  the  chest  and  keeping  water  from  being  blown  in  through 
the  seams.  A  puckering  string  around  the  margin  of  the  hood  enables 
it  to  be  drawn  tightly  around  the  face  and  a  puckering  string  at  the 
lower  margin  of  the  jumper  draws  it  tightly  around  the  waist  when  tied. 
The  wrists  are  supplied  with  snap  catches  so  that  the  sleeves  may  be 


CLOTHING 


189 


ibled  in  to  lit  the  wrists.     For  purposes  of  ventilation  four  eyelets 
<•  placed  under  each  arm  pit. 

The  trousers,  made  of  the  same  material,  are  large  and  roomy, 
tapering  at  the  ankle  where  they  are  fastened  by  catches  which  enable 
their  close  fitting  to  the  ankle.  The  trousers  are  merely  large  garments 
which  slip  on  without  any  buttons  and  which  are  fastened  at  the 
;  by  a  heavy  puckering  string  which  runs  through  the  large  seam 
at  the  waist  band. 


51. — The  mackintosh  hooded  jumper.     Note  the  draw-string  around  the 
fin  of  the  hood;  also  the  protecting  flap  at  the  neck.     This  is  an  excellent 
garment  for  wear  in  cold,  wet,  weather. 


Tin.    Avi  ITO&'S    CUM  HIM; 


»fo  resi>t  the  chilling  effect  resulting  from  wind  and  altitude  the 
tor  should  he  warmly  dad.  Likewise,  in  order  to  protect  the  head 
against  injury  the  head  guard  should  be  of  rigid  character,  light  and 
warm.  The  necessity  for  quirk  action  in  the  Operation  of  the  airplane's 
control^  require-  that  the  clothing  be  of  such  character  as  to  hamper 
in  no  way  the  motions  of  the  wrisl>and  arms.  At  times  these  motions 
must  be  made  with  lightning  speed  and  any  hampering  garment  might 
b€  a  factor  in  prodm  ing  disa>trous  accident. 

In  i in  U.  S.  Navy  a  helmet  made  of  extra  heavy  sole  leather  having 
cones  and  a  wool  tleece  lining  i-  worn.  When  in  the  machine  the 
tor  is  strapped  to  a  small  seat,  works  in  a  very  small  cockpit, 


igo 


NAVAL  HYGIENE 


having  only  a  few  inches  of  elbow  room.  When  the  airplane  dives, 
turns,  or  climbs  at  sharp  angles  the  lurch  suddenly  may  strike  the  head 
of  the  aviator  against  the  edge  of  the  fusilage,  causing  severe  injuries  to 
face  and  scalp. 

The  heavy  sole  leather  helmet  which  fits  well  down  over  the  head 
and  is  strapped  under  the  chin  with  heavy  sole  leather  ear  pieces  gives 
much  protection.  The  openings  of  the  ear  cones  are  directed  backward 
and  protect  the  external  auditory  meatus  from  the  blowing  of  the  wind 


FIG.  52. — Aviator's  clothing.  A  and  B  represent  heavy  black  leather  gauntlet 
and  mitten  respectively.  C  shows  the  heavy  wading  shoe;  note  the  eyelets  for 
escape  of  water.  D,  goggles  made  of  non-splinterable  glass.  E,  heavy  sole 
leather  helmet;  note  the  ear  protectors  having  openings  directed  backward.  F, 
leather  face  mask  having  goggles  of  non-splinterable  glass. 

across  the  mouth  of  the  canal  and  consequent  interference  with  hearing. 
This  helmet  has  prevented  many  severe  injuries  of  scalp  and  face. 

During  severe  weather  a  soft  leather  face  mask  with  goggles  made 
of  non-splinterable  glass  affords  protection  to  the  face.  In  weather  less 
severe  a  safety  glass  goggle  made  of  non-splinterable  glass  is  worn. 
These  goggles  may  be  strapped  securely  to  the  face  and  are  so  mounted 
that  the  eyes  receive  thorough  protection  from  the  wind. 

The  body  is  protected  by  a  two-piece  suit  of  tan  leather  sufficiently 
large  to  permit  the  retention  of  a  layer  of  warm  air  of  considerable 
thickness  about  the  body  of  the  aviator. 


CLOTHING 


IQI 


The  coat  has  a  heavy  detachable  lining  and  the  garments  are  made 
of   leather   which   has   been   specially   treated  to  resist  absorption  of 
watrr.     The  trousers  are  lied  at  the  bottom  or  else  in>erted  into  heavy 
« --lined  leather  boot  i. 

The  aviator  in  the  naval  service,  especially  at  training  stations,  may 

have   to   work   around  his   machine  in  shoal  water.     For  this  pur- 

•' waders"  or  mackintosh  cloth  trousers  having  stocking  feet  are 

\\vrn  with  brooms  made  of  heavy  leather  and  canvas.     These  brogans 

have  heavy  hobnails  on  the  soles  and  heels  and  have  eyelets  on  the 


Heavy  two-piece    leather    suit.     B,  aviator 

fully  clad  in  leather  suit,  heln.  .      C,    "wa«: 

allowing  water  to  flow  in  and  out.     These  heavy  shoes  are  worn 
for  the  purpose  of  protecting  the  feet  of  the  "waders"  mentioned  above. 
The  hand>  are  protected  by  black  leather  gauntlets  which  are  wool 
lim-d,  al>o  a   wool-liiu-(l  black  leather  mitten  is   used.      These    mittens 
and   gauntlets   commonly   are    worn    over    warm  gloves.     Electrically 
•  •d  clothing  is  worn  by  aviators  who  now  are  lighting  in  the  cold 
air  at  an  altitude  of  20,000  feet  above  the-  earth's  BUlfl 


CHAPTER  XIV 
PARTS  OF  THE  SHIP  AND  HEALTH. 

The  Deck  Watch. — The  watch  on  deck  is  stood  in  periods  of  four 
hours  each  except  that  the  period  from  4  :oo  to  8  :oo  p.m.  is  "dogged" 
or  divided  into  two  watches  of  two  hours  each  so  as  to  give  an  un- 
even number  of  watches  and  so  prevent  the  men  from  standing  the 
same  watch  each  day. 

The  duties  of  the  watch  officers  and  crew  require  that  they  lose  a 
certain  amount  of  rest  at  night.  Also  those  who  stand  watch  on  deck 
are  exposed  to  the  weather  conditions  which  prevail.  In  the  summer 
and  in  the  tropics  awnings  should  be  spread  to  protect  against  the  sun, 
and  in  rainy  and  winter  weather  appropriate  clothing  must  be  worn 
for  protection.  Weather  screens  should  be  spread  to  protect  against 
wind  and  weather.  On  the  steel  bridge  linoleum  or  wooden  gratings 
should  be  placed  for  the  protection  of  the  feet  of  watch  standers  both 
against  the  cold  and  heat.  Also  the  wood  gives  resilience  not  possessed 
by  steel  and  affords  relief  to  the  watch  standers. 

To  protect  the  eyes  against  the  glare  in  the  sunlight  or  tropic 
amber  or  dark  glasses  should  be  worn.  Those  standing  watch  shoulc 
have  keen  vision  and  hearing  in  order  properly  to  interpret  signals  an< 
avoid  danger. 

The  nervous  strain  from  standing  watch  in  a  fog  or  at  night  ten< 
to  break  down  those  of  unstable  nervous  system. 

The  irregular  hours  for  sleep  and  the  hurried  meal  taken  by  thos 
going  on  watch,  or  the  delayed  meal  taken  alone  by  those  coining  ol 
watch,  operate  to  cause  irregularity  of  digestive  function. 

During  the  morning  hours  when  the  deck  is  being  scrubbed  th< 
on  watch  unless  in  rubber  boots  will  get  their  shoes  saturated  wil 
salt  water  and  this  consequent  chilling  tends  to  produce  respirator; 
diseases,  as  well  as  tonsilitis  and  rheumatic  affections. 

Men  on  watch  in  the  crow's  nest  should  not  be  kept  on  duty  long< 
than  two  hours  in  cold  weather. 

Search  Lights. — Men  operating  search  lights  are  exposed  to  th( 
effects  of  the  rays  upon  the  eyes.  These  cause  marked  conjunctiviti 

192 


PARTS  OF   THE  SHIP  AND  HEALTH 


193 


id  severe  rclinitis  with  photophobia.     Protective  goggles  should  be 
)rn. 

Life  Lines. — Around  the  decks  of  ships  are  situated  the  life  lines 
which  protect  membe's  of  the  crew  from  falling  overboard  during 


FIG.  54. — During  certain  conditions  the  smoke  and  gases  from  the  smoke  pipe 
make  the  fighting  tops  almost  uninhabitable.     Smoke  helmets  are  needed. 

activities  in  the  day  or  at  night.     These  lines  are  situated  ap- 
proximately  at   distance  <>l"   i.  I,  and  3  feet  above  the  deck.     When 


ia 


IQ4  NAVAL  HYGIENE 

ships  are  cleared  for  action  the  lines  are  taken  down.  Men  should 
not  be  allowed  to  sit  on  benches  near  them.  The  writer  saw  a 
case  of  drowning  resulting  from  a  man's  lying  on  a  bench  at  night, 
falling  asleep,  and  rolling  overboard  between  the  life  lines.  (See 
Fig.  15-) 

Fighting  Tops.- — During  target  practice  and  in  time  of  action  when 
range-finding  parties  occupy  the  fighting  tops,  discomfort  may  be 
extreme  because  of  the  smoke  from  the  ship's  smoke  pipes.  If  the 
wind  is  in  the  right  direction,  the  hot  air  and  smoke  as  well  as  gases 
of  combustion  produce  serious  discomfort;  also,  cinders  are  apt  to 
blow  into  the  eyes  and  to  cause  injury  by  reason  of  the  fact  that  they 
may  be  almost  red  hot  when  striking  the  eye  or  skin.  The  parties 
in  the  fighting  tops  also  suffer  from  extremes  of  heat  and  cold,  depending 
upon  the  weather.  In  summer  the  heat  and  glare  of  the  sun  produce 
sunburns  and  retinal  hyperaesthesia.  In  winter  the  lofty  position  is 
exposed  to  the  full  sweep  of  cold  winds  and  methods  of  heating  cannot 
well  be  employed,  although  an  electric  heater  is  a  possibility.  The 
absence  of  cover  leaves  the  occupants  of  the  fighting  top  exposed  to 
rain,  sleet,  and  snow.  And  the  surface  upon  which  they  stand,  being 
of  cold  steel,  readily  conducts  the  heat  from  the  feet  and  causes  rapid 
chilling.  Injury  from  falls  received  while  climbing  to  or  from  the 
fighting  tops  is  not  uncommon. 

The  Engine  Room. — The  engine  room  is  hotter  than  the  fire  room. 
That  of  a  reciprocating  engine  is  hotter  than  the  engine  room  of  a 
turbine  engine.  The  wild  heat  from  the  pipes  and  engines,  together 
with  steam  leaks,  causes  an  extremely  uncomfortable  temperature  at 
times. 

The  removal  of  wild  heat  should  be  accomplished  through  natural 
and  artificial  ventilation.  In  time  of  action,  when  battle  hatches  are 
down,  the  development  of  high  temperatures  becomes  serious.  Insula- 
tion (lagging)  should  be  employed  wherever  possible  to  prevent  escape 
of  heat  from  pipes,  boilers,  evaporators,  condensers,  and  so  forth,  thus 
limiting  wild  heat. 

The  engine-room  force  works  under  conditions  somewhat  similar 
to  those  of  the  fire-room  force  and  tends  also  toward  physical 
deterioration. 

At  times  the  ventilating  system  will  supply  fresh,  cold  air  delivered 
directly  upon  the  body  of  the  overheated  engineer  who  may  be  on 
the  engine  room  platform.  This  predisposes  to  respiratory  a:id 


PARTS  OF  THE  SHIP  AND  HEALTH 


muscular  affections.  The  man  at  the  throttle  should  be  keen  and 
alert,  as  upon  the  quickness  of  his  obedience  to  signals  may  depend 
the  safety  of  the  ship. 


-CMP   AND    RED  LEAD   JOINT.^- 
PRACTICALLY    AIRTIGHT 


CORK   PAINT     ABOUT  %4 


,&COMP.  CORK     SLABS 


IP  AND  RED  LEAD 
TIGHT   JOINT 


rtNER    FOR   CEILING 

(SIDE    SURFACE 
OSS- OR  ENAMEL  FINISH   IN 
OFFICERS    QUARTERS    AND 

MCK   QUARTERS     FLAT 

ITE     IN     CREW     5PACE. 


—  VERTICAL    SECTION  — 


—  HORIZONTAL     SECTION 


FIG.  55. — Cork  slabs  are  bolted  to  bulkheads  to  limit  the  escape  of  wild  heat. 
The  slabs  are  shown  in  place.     (Gate-wood.) 

The  platforms,  made  of  metal  gratings  upon  which  much  of  the 
engineer's  watch  is  stood,  should  be  insulated  as  far  as  possible  to 
prevent  the  relaxing  effect  of  heat  upon  the  ligaments  of  the  feet 
d  the  sweating  which  results  from  exposure  to  the  high  temperature. 


Ip6  NAVAL  HYGIENE 

As  in  the  fire  room,  the  problem  of  drinking  water  supply  is  un- 
satisfactorily settled. 

The  engine-room  force  shows  a  high  admission  rate  per  thousand 
for  the  following  classes:  diseases  of  the  digestive  system,  81  to  83; 
non-venereal  infective  diseases,  76.19;  and  wounds  and  other  injuries 
79.27  (Surgeon  General's  report  for  1917). 

The  engine-  and  fire-room  forces  on  coal-burning  ships  are  exposed 
to  much  heat  while  on  duty.  This  should  be  borne  in  mind  during 
inspections,  parades,  etc.,  on  deck.  The  writer  has  seen  the  engineer's 
force  thoroughly  chilled  on  deck  in  a  cold  wind,  although  clad  in  the 
same  uniform  as  the  deck  force  which  had  become  inured  to  the  chilling 
blast. 

The  Fire  Room. — The  fire  rooms  on  board  ship  are  those  spaces  in 
which  firemen  attend  the  fires  which  generate  heat  and  power.  The 
temperature  in  the  fire  rooms  varies,  depending  upon  the  type  of  ship 
and  whether  oil  or  coal  fires  are  maintained.  In  the  coal-burning 
ships  high  temperatures  are  often  seen,  especially  in  the  tropics.  It 
is  said  that  the  temperature  in  the  fire  room  reaches  160°  to  i8o°F. 
on  the  trans- Atlantic  liners,  and  the  temperature  in  the  fire  room  of  the 
old  Texas  in  Cuba  during  the  Spanish-American  War  is  said  to  have 
risen  to  i98°F.  These  temperatures  are  exceptional.  On  the  large 
ships  of  the  Navy  the  fire  room  temperature  seldom  rises  above  i25°F.; 
more  often  it  is  about  110°  on  the  coal-burning  ships  and  even  less  on 
the  oil  burners. 

The  coal  is  brought  from  the  coal  bunkers  and  dumped  on  the  cast- 
iron  bilge  plates  which  constitute  the  deck  of  the  fire  room.  The 
firemen  then  shovel  the  coal  into  the  furnaces  or  slice  the  fires  as  oc- 
casion may  require. 

During  the  process  of  throwing  coal  upon  the  fires  and  slicing  the 
fires  much  heat  is  radiated  out  through  the  open  furnace  doors.  A 
certain  amount  of  ash  and  coal  dust,  as  well,  is  thrown  into  the  atmos- 
phere. The  removal  of  the  heated  air  is  accomplished  through  exhaust 
fans  and  through  the  interval  between  the  smoke  pipe  and  the  smoke- 
pipe  casing  through  which  heated  air  rises.  The  fires  are  burned 
under:  (a)  Natural  draft;  (b)  Forced  draft. 

(a)  Under  natural  draft  conditions,  all  of  the  openings  leading  to 
and  from  the  fire  room  remain  open,  thus  permitting  the  entrance  of 
air  to  the  fires  under  natural  conditions. 

(b)  Forced  draft  is  employed  when  for  any  reason  it  is  desired  to 


PARTS  OF  THE  SHIP  AND  HEALTH 


I97 


generate  steam  more  rapidly  for  power  or  speed.  When  operating 
mder  forced  draft  all  natural  openings  are  closed,  and  air  is  forced 
ugh  supply  intakes  into  the  closed  compartment,  there  being  no 

outlet  except  through  the  furnace  doors,  i.e.,  over  the  fires.  This  in- 
•reases  combustion  and  heat  generation.  Under  forced  draft  the  air 


und( 
,hro 


Fit;.  56. — This  sketch  shows  the  blowers  at  the  base  of  the  smoke  pipe,  connec- 
ns  enabling  forced  draft,  and  the  interval  between  the  smoke  pipe  and  smokc- 
••tj.     The  arrow  shows  the  direction  of  air  current  in  this  interval.      ((/<//«•- 
0 


ure  within  the  fire  room  is  increased  several  inches,  waeer  gauge, 
ve  the  surrounding  atmospheric  pressure,  and  this  excess  of  fresh 
lir,  together  with  the  velocity  at  which  the  stream  of  air  is  supplied, 
causes  the  temperature  in  the  tire  room  to  be  lower  than  it  would  be  if 
natural  draft  were  being  used.  As  the  stream  of  air  rushes  from  the 


198  NAVAL  HYGIENE 

louvers  of  the  supply  ducts  to  the  fires  a  stream  or  current  is  established 
which  causes  eddying  in  remote  corners,  but  prevents  thorough  aeration 
of  the  fire  room. 

The  work  in  the  fire  room  is  very  heavy,  and  tends  toward  produc- 
tion of  hernias,  also  myalgia  is  common  among  the  fire-room  force 
working  under  high  temprature  who  expose  themselves  to  cold 
drafts  for  relief  from  their  discomfort.  Burns  are  not  uncommon 
in  the  fire  room  and  likewise  injuries  resulting  from  the  blowing  out  of 
gauge  glasses. 

As  their  work  is  performed  under  artificial  illumination  the  fire- 
room  force  is  taken  from  the  sunlight  and  fresh  air  on  deck;  conse- 
quently, there  is  a  tendency  to  anemia  and  disease  of  the  respiratory 
system.  These  men  also  show  a  high  rate  per  thousand  for  diseases 
of  the  digestive  system  and  diseases  of  the  infective  type  (non- venereal), 
the  rates  being  110.45  and  134-66  respectively  in  1917.  At  general 
muster  the  bleached-out  appearance  of  the  "black  gang,"  as  the  engi- 
neer's force  is  sometimes  called,  is  very  striking  when  compared  with 
the  ruddy,  healthy  tanned  faces  of  the  deck  force. 

The  fire-room  force  after  coming  off  watch  should  be  encouraged 
to  come  on  deck  to  get  needed  fresh  air  and  sunlight.  They  should  be 
permitted  to  come  in  clean  dungarees.  The  writer  has  seen  men  of  the 
fire-room  force  deterred  from  coming  up  on  deck  to  rest  because  they 
were  required  to  shift  into  clean  "whites"  in  order  to  appear  on  deck, 
and  this  necessitated  changing  again  into  dungarees  before  going  back 
on  watch. 

The  medical  officer  should  familiarize  himself  with  the  conditions 
under  which  these  men  work  and  the  knowledge  can  be  obtained  only 
by  going  into  the  fire  room  and  spending  time  there  making  observa- 
tions under  actual  working  conditions. 

Sweat,  discomfort,  and  dirt  are  the  price  of  this  knowledge.  The 
conscientious  medical  officer  must  obtain  it. 

The  problem  of  supplying  fresh,  cool  drinking  water  to  the  fire-room 
force  has  not  yet  been  solved  satisfactorily.  A  portable  water  cooler, 
having  a  bubbling  well  faucet  and  in  which  a  positive  air  pressure  may 
be  developed  has  been  used  and  discarded.  The  drinking  terminals  of 
such  apparatus  are  difficult  of  operation  because  of  the  amount  of  coal 
dust  which  settles  upon  the  terminals,  and  even  where  such  scuttle-butt 
arrangements  have  been  installed,  preference  is  given  by  the  men  to  a 
bucket  or  pitcher  containing  ice  and  drinking  cup  or  glass.  This  com- 


PARTS   OF   THE   SHIP  AND  HEALTH  1 99 

on  drinking  cup  should  be  discouraged,  and  every  man  should  have 
is  own  glass.     Formerly  the  use  of  barley  water  was  much  in  vogue 
among  stokers  but  its  use  appears  to  have  become  less  frequent. 

Provision  should  be  made  in  the  fire  room  for  proper  disposal  of 
creta. 

The  bilges  under  the  fire  room  should  be  inspected  frequently  by 
e  medical  officers  to  insure  that  nuisances  are  not  being  committed, 
d  that  the  bilges  are  dry  and  sweet. 

The  Handling  Room. — The  handling  room  is  located  at  the  base  of 
turret  and  is  the  space  in  which  charges  and  shell  for  the  turret  guns 
e  placed  in  the  ammunition  hoists  to  be  sent  up  to  the  guns.   The 
shell  and  charge  weigh  several  hundred  pounds  each,  and  as  they  are 
ing  brought  from  the  adjacent  magazines  crushing  injuries  to  the 
t  and  hands  of  the  men  often  occur. 

Also  injury  is  not  uncommon  among  those  working  the  ammunition 
ists. 

Grave  accident  has  resulted  from  flare-backs  after  turret  guns  are 
fired.  When  the  breech  was  opened  grains  of  burning  powder  fell  from 
the  breech,  dropped  upon  waiting  powder  charges  in  the  handling  room 
and  caused  explosion. 

tThe  above-mentioned  injuries  are  more  apt  to  occur  when  competi- 
m  in  drills  is  high  and  men  are  working  at  top  speed. 
To  prevent  danger  of  flare-backs  steel  shutters  have  been  installed 
tween  the  handling  room  and  the  guns  above.     These  shutters  open 
d  close  automatically  as  the  car  of  the  ammunition  hoist  passes  up 
and  down. 

As  a  further  safeguard  against  the  " flare-back"  a  positive  air  pres- 
>ure  is  placed  in  the  turret  guns,  and  when  the  breech  of  a  big  gun  is 
opened  the  outrush  of  air  through  the  gun  carries  away  through  the 
muzzle  burning  grains  of  powder  and  gases  of  combustion  also. 

I  The  illumination  of  the  handling  rooms  and  shell  rooms  should  be 
adequate  to  prevent  accident.  The  air  in  the  handling  room  and  the 
spaces  occupied  by  reserves  in  the  powder  division  soon  becomes  per- 
ceptibly "doa  brief  period  of  occupancy.  On  most  ships  this 
could  be  improved. 

The  Ladders.  —The  ladders  on  board  ship  are  vertical  or  inclined. 
They  may  be  a  potential  source  of  infection  with  the  filth-  and  sputum- 
borne  diseases.  In  ascending  and  descending  the  vertical  ladders,  the 
rungs  must  be  handled.  While  on  the  inclined  ladders,  the  hand  rope 


200 


NAVAL  HYGIENE 


or  railing  must  be  handled  by  those  using  the  ladders.     If  hands  are 
soiled  with  sputum,  urine,  feces,  or  pus,  infection  may  be  spread. 

Formerly  the  treads  of  the  ladders  were  of  cellular  construction  and 
made  of  galvanized  iron.  The  construction  would  resemble  the  greatly 
magnified  horizontal  section  through  a  wasp's  nest.  These  ladders 
were  found  to  be  difficult  to  keep  clean  and  were  very  dusty.  They' 
have  been  superseded  by  a  composite  tread  made  of  alternating  strips 
of  galvanized  iron  and  wood,  the  former  being  about  a  quarter  of  an 


FIG.  57. — A  represents  a  composite  ladder  tread  made  of  strips  of  iron  and 
wood  bolted  together.  This  is  a  much  more  sanitary  tread  than  the  cellular  metal 
tread,  B.  C,  a  hatch,  its  cover,  the  ladder  leading  down  from  it  and  the  hand- 
ropes  for  use  of  those  descending  the  ladder. 

inch  in  width  and  the  latter  at  least  i  inch  in  width.  This  tread  has 
been  found  to  be  very  durable,  is  easily  cleaned,  and  gives  a  more 
secure  footing.  When  for  purposes  of  cleaning  the  ladders  are  unship- 
ped from  the  hatches  the  latter  should  be  barred  to  prevent  persons 
attempting  to  descend  by  the  usual  route.  Coming  from  bright 
light  on  deck  the  eye  looking  into  the  darker  hatch  sometimes  fails 
to  detect  the  absence  of  the  ladder. 

The  Galley. — The  ship's  kitchen,  or  galley,  should  be  effectively 
screened  against  flies.  It  should  be  situated  on  the  upper  deck  in  or- 


PARTS  OF  THE  SHIP  AND  HEALTH 


201 


to  secure  a  maximum  of  ventilation  at  all  times  and  to  be  as  cool 
practicable  in  warm  weather. 

The  ranges  should  be  covered  with  hoods  in  order  that  the  odors 
cooking  food  may  pass  with  the  heated  air  up  through  the  ventilating 

js.     The  ranges  are  heated  by  coal,  oil,  or  electricity. 

The  various  cooking  utensils  and  interior  of  the  galley  should  be 

>t  scrupulously  clean  and  a  constant  war  should  be  waged  against 
German  cockroach  which,  like  the  poor,  is  always  with  us. 


FIG.  58. — Officers'  galley  or  kitchen. 

R  Abundant  supply  of  hot  and  cold  water,  as  well  as  live  steam,  should 
supplied  to  the  galley  and  no  salt  water  connection  should  be  per- 
mitted. The  employment  of  the  latter  might  result  in  introduction 
polluted  harbor  \\ati-r  and  filth-borne  infections. 
The  personnel  of  the  galley  should  be  sound  in  body  and  clean  of 
it.  Kach  member  should  be  examined  to  determine  whether  he 
typhoid  carrier,  and  if  found  to  be  such  he  should  not  be  permitted 


2O2 


NAVAL  HYGIENE 


to  work  in  the  galley.     Those  suffering  with  tuberculosis  or  other 
communicable  disease  should  be  excluded. 

The  members  of  the  galley  force  should  be  inspected  weekly  to 
determine  the  presence  of  concealed  venereal  disease,  and  should 
be  cautioned  to  report  for  treatment  immediately  upon  feeling  in- 
disposed. The  spread  of  diphtheria,  Vincent's  angina,  and  the  like 
may  be  prevented  by  attention  to  this  detail.  Persons  having  a  skin 


FIG.   59. — The  galley  of  the  general  mess  on  board  ship.      Note  the  "coppers" 
for  boiling  foods.     The  deck  is  of  white  ceramic  tile. 

disease  (especially  a  suppuration)  or  injuries  to  the  hands  should  not 
handle  food.  The  tendency  to  wash  personal  linen  and  dry  it  in  the 
galley  should  be  nipped  in  the  bud,  and  loafing,  smoking,  and  sleeping 
in  the  galley  should  be  prohibited. 

The  Bakery. — The  bakery  should  be  located  on  the  main  deck 
where  there  is  adequate  escape  for  the  heated  air  which  would  be  un- 
comfortable between  decks. 

The  floor  should  be  tiled.     An  abundant  supply  of  fresh  water— 


PARTS  OF  THE  SHIP  AND  HEALTH 


203 


hot  and  cold — should  be  available.  The  ranges  should  be  heated 
by  oil  or  by  electricity,  preferably  the  latter.  The  dough  mixer 
should  be  carefully  cleaned  after  each  use  as  should  be  the  mixing 
tables.  The  pans  should  be  scrupulously  clean  and  should  not  be 
permitted  to  contain  the  charred  remains  from  previous  bakings.  The 
kery  should  be  supplied  with  fresh  water  not  warm  enough  to  inter- 
wit  h  the  action  of  the  yeast.  At  times  the  mixing  of  the  dough 


FK..   60. — The  meat  slicer  in  the  galley  of  the  general  it 

ith  water  which  is  loo  warm  interferes  with  the  normal  rising  of  tin- 
Bread  lockers  should  be  of  metal.     The  interior  should  be 
>y  of  access  to   facilitate  cleaning,  and  no  woodwork  should   be 
>ermittcd   as  it  offers   breeding  places  for  the   German  cockroach. 
The  bakeshop  should  be  thoroughly  cleaned  with  hot  water  each  day 
and  no  filth  should  be  allowed  to  accumulate  in  corners  for  the  sup- 
>rt  of  vermin.     Corners  and  angles  may  well  be  sprayed  with  a 
hose  once  each  week.      Dish  towels  and  utensils  used  should 
kept  clean.     Towels  should  not  he  stowed  wet. 


204  NAVAL  HYGIENE 

The  personnel  of  the  bakery  should  be  free  from  infectious  diseases, 
and  should  not  be  permitted  to  smoke,  eat,  sleep,  wash  clothing,  or 
stow  it  in  the  bakery. 

All  windows  and  doors  should  be  screened  against  flies. 

The  handling  of  bread  should  be  done  in  a  clean  manner  and  when 
issued  to  mess  cooks  they  should  not  be  permitted  to  receive  it  in 
their  sweaty  arms  or  upon  soiled  sleeves.  The  bread  should  be  put 
upon  trays  and  transported  to  the  mess  tables. 


FIG.  61. — The  bakery.     Pouring  dough  from  the  mechanical  mixer. 

The  Barber  Shop. — Supervision  of  the  barber  shop  by  the  medical 
officer  is  an  important  duty,  the  careful  attention  to  which  will  prevent 
spread  of  infectious  disease.  The  following  regulations  are  suggested 
for  control  of  barber  shops  on  board  ship,  they  having  been  prepared 
and  found  satisfactory  during  my  service  on  the  U.  S.  S.  North 
Dakota: 

i.  No  barber  shall  shave  a  man  when  the  surface  to  be  shaven  is 
broken  out  or  inflamed.  The  name  of  any  such  man  shall  be  furnished 


PARTS  OF  THE  SHIP  AND  HEALTH 


205 


surgeon  and  the  man  directed  to  report  to  the  surgeon.  The 
rgeon  will  advise  the  barber  whether  it  is  safe  to  shave  the  man  in 
icstion.  The  same  regulation  applies  to  any  man  whose  scalp  is 
lamed  or  broken  out. 

2.  No  person  suffering  from  a  venereal  disease  or  any  communicable 

shall  be  permitted  to  act  as  barber. 

3.  Each  barber  shall  wear  a  clean  washable  apron  or  coat. 

4.  Towels  and  wash  cloths  used  in  the  service  of  each  man  must 
>e  freshly  laundered  before  use  upon  another  person. 


FIG.  62. — The  bread  room.      Note  the  mechanical  bread  slicer  at  the  extreme 

right. 


5.  Dusters  shall  not  be  used.     The  necessary  wiping  away  of  cut 
hair  from  face  and  neck  shall  be  done  by  nu-ans  of  a  clean  towel  or  a 
clean  wash  cloth. 

6.  Alum  or  other  material  used  to  stop  flow  of  blood  shall  be  used 
in  powdered  or  liquid  form  only  and  shall  be  applied  on  a  clean  towel. 

7.  Either  a  clean  towel  or  clean  new  paper  shall  be  used  on  the 
head  rest  for  each  man. 


206 


NAVAL   HYGIENE 


8.  No  powder  puffs  or  sponges  shall  be  used  on  any  man. 

9.  Each  barber  shall  wipe  his  hands  after  each  shave  or  haircut 
with  a  towel  moistened  in  a  disinfecting  solution,  or  wash  his  hands 
immediately  before  serving  any  man. 

10.  Hair  brushes  shall  be  washed  daily  and  disinfected  in  the  form- 
alin chamber. 

11.  The  barber  shall  sterilize  all  mugs,  shaving  brushes,  razors, 
clippers,  scissors,  tweezers,  needles,  lances,  combs,  and  soap  before  each 


FIG.  63. — Baking  pies  for  the  crew. 

separate  use,  by  immersion  in  boiling  water.     Razors  must  be  dipped 
in  boiling  water  after  stropping  and  before  each  use. 

12.  The  surgeon  will  furnish  the  head  barber  with  a  list  of  men  who 
are  under  treatment  for  dangerous  venereal  or  other  contagious  disease, 
and  such  men  if  permitted  to  be  served  by  any  barber  shall  have  each 
his  own  separate  razor,  comb,  brush,  clippers,  etc.,  which  on  no  account 
shall  be  used  on  any  other  man. 

13.  The  barber  shop  shall  not  be  used  as  a  berthing  or  sleeping  space. 


PARTS  OF  THE  SHIP  AND  HEALTH  207 

4.  The  removal  of  cut  hair  from  the  deck  shall  be  done  in  such 
er  as  to  produce  a  minimum  amount  of  dust. 
e  Brig. — Prisoners  in  the  "brig"  or  ship's  prison  should  be 

ited  by  the  medical  officer  twice  daily,  morning  and  evening;  should 
have  proper  exercise  prescribed  for  them;  and  if  on  reduced  rations 
should  be  the  subjects  of  special  care.  "Bread  and  water"  never  is 
justifiable. 

Before  confinement,  for  a  period  longer  than  ten  days,  upon  sentence 
of  court-martial,  the  sentenced  man  must  be  examined  by  the  medical 
officer,  who  is  required  to  certify  over  his  signature  that  the  sentence 
im  >osed  will  not  seriously  impair  the  health  of  the  prisoner. 

Care  must  be  taken  that  the  nutrition  of  a  man  so  confined  shall 
noi:  suffer. 

When  an  intoxicated  man  is  placed  in  the  "brig"  to  sober  up,  the 
nu-dical  officer  should  satisfy  himself  that  the  man's  physical  condition 
<>d.     Men  profoundly  poisoned  with  alcohol  have  died  while  so 
confined. 

The  medical  officer  should  always  satisfy  himself  of  the  suitability 
of  a  space  before  permitting  men  to  be  confined  in  it.  The  minimum 
dinensions  of  space  for  confinement  of  a  prisoner  are  fixed  by  U.  S. 
Navy  regulations  as  follows: 

"Not  less  than  6  feet  long  and  3^  feet  broad  with  the  full  height 
between  decks  and  shall  be  properly  ventilated.  They  (these  spaces) 
sh;.ll  not  be  altered  without  authority  of  the  Navy  Department." 

I    is  further  provided  by  U.  S.  Navy  regulations  that  prisoners  shall 

be  confined  in  spaces  other  than  those  designated  by  the  Navy 

Department,  except  in  cases  of  necessity,  when  "The  medical  officer 

shall  be  called  upon  to  report  whether  such  spaces  are  fit  for  prison 

The  prescribed  dimensions  of  the  brig  guarantee  adequate  cubic 

for  each  occupant.     The  entire  interior  surface  of  the  brig  should 

be  made  of  steel  which  should  be  thoroughly  cleansed  after  each  occu- 

n.     The  space  should  he  lighted  by  indirect  electric  lighting,  the 

fixmres  l>eiii£  attached  to  the  deck  above  and  covered  by  a  strong 

:iu.  so  that  should  necessity  arise  a    maniac  could  be  confined 

without  endangering  himself  or  the  installation.     The  lights  should  be 

controlled  from  outside. 

Since  men  who  are  confined  in  the  brig  are  restrained  from  following 
their  own  inclinations,  even  necessities,  the  ventilation  and  heating 


208  NAVAL  HYGIENE 

should  receive  especial  care,  and  the  ducts  supplying  fresh  air,  whether 
heated  or  not,  should  be  controlled  so  that  unauthorized  tampering 
with  the  supply  will  be  rendered  impossible. 

Special  care  also  should  be  exercised  that  persons  confined  in  the 
brig  are  sufficiently  clad,  have  an  adequate  supply  of  bedding,  and  are 
fed  and  policed  regularly. 

The  brig  spaces  should  be  so  constructed  as  to  prevent  access  of 
unauthorized  'persons.  Smoking  should  not  be  permitted,  and  the 
medical  officer  should  assure  himself  that  persons  in  confinement  have 
regular  baths,  clean  clothing,  and  under  proper  guard  are  given  oppor- 
tunity to  exercise  in  fresh  air  and  daylight,  especially  if  the  period  of 
confinement  exceeds  more  than  a  day  or  two. 

Effort  should  be  made  to  prevent  physical  suffering  on  part  of  those 
confined,  yet  the  brig  should  not  be  made  a  comfortable  asylum  for 
shirks  and  ne'er-do-wells. 

The  Butcher  Shop. — The  butcher  shop  should  be  located  in  the 
superstructure  on  the  weather  deck  where  it  will  get  as  much  fresh  air 
and  sunlight  as  possible.  Its  deck  should  be  tiled  in  order  that  drip- 
pings from  the  meat  may  not  be  absorbed  but  may  be  readily  cleaned. 
Doors  and  windows  should  be  screened  as  should  be  the  terminals  of 
the  ventilating  system  entering  the  butcher  shop.  If  screening  is  im- 
practicable the  shop  should  be  kept  dark  during  day  time  in  order  that 
flies  may  not  be  attracted. 

Meat  should  be  drawn  from  the  cold  storage  at  a  fixed  hour  morning 
and  evening  and  taken  to  the  butcher  shop  to  thaw  and  be  dressed  and 
prepared  for  the  galley.  While  thawing,  the  meat  should  be  left  in  its 
wrappers  and  should  not  be  permitted  to  lie  on  the  deck.  Meats 
usually  are  inspected  before  being  placed  in  cold  storage  and  in  the  U.  S. 
Navy  bear  the  stamp  of  a  meat  inspector  of  the  Bureau  of  Animal 
Industry  of  the  Department  of  Agriculture.  These  meats  are  inspected 
also  by  the  medical  officer  immediately  before  being  taken  on  board 
ship.  If,  however,  when  thawing  has  taken  place  the  meat  appears 
to  be  of  questionable  quality  the  medical  officer  should  be  notified  at 
once  in  order  that  his  opinion  and  recommendation  may  be  had. 

Partially  decomposed  meat  and  trimmings  which  cannot  be  utilized 
as  food  should  be  thrown  overboard  or  incinerated,  and  bones  which 
cannot  be  utilized  in  the  soup  kettle  should  be  similarly  treated. 
Scraps  of  meat  should  not  be  allowed  to  stand  uncovered  in  the 
butcher  shop.  They  should  be  disposed  of  as  necessity  may  indicate, 


PARTS  OF  THE  SHIP  AND  HEALTH 


2OQ 


ut  not  left  to  decompose  and  attract  flies.  The  surface  of  the  meat 
Ini  k  should  be  frequently  scraped,  scrubbed,  and  kept  smooth. 
Instruments  including  the  meat  grinder  should  be  kept  scrupulously 
an.  The  deck  should  be  regularly  scalded  with  a  steam  hose  to 
nse  it  and  to  prevent  breeding  and  presence  of  insects.  The  drains 
should  receive  especial  attention.  If  necessary,  permanganate  of 
p>otash  solution,  1-500,  or  a  solution  of  chlorinated  lime  may  be  poured 
through  the  drains  to  deodorize.  Deodorizers  may  be  used  on  occasion, 


Fu;.   64. — The  butcher  shop. 


Meat  from  cold  storage  thawing, 
tile  deck. 


Note  ceramic 


t  should  not  be  permitted  to  replace  ordinary  cleanliness.     The  odor 
decomposing  meat  should  be  prevented  in  the  butcher  shop  in  order 
t  tainted  meat  may  be  recognized  more  easily. 
Personnel  of  the  Butcher  Shop.— The  butcher  and  his  assistants 
hould  be  frequently  inspected  for  the  presence  of  disease,  and  no 
isease  carriers  should  be  allowed  to  assist  in  the  preparation  of  food. 
e  butcher  should  be  required  to  keep  his  person  and  clothing  scrupu- 


210  NAVAL   HYGIENE 

lously  clean,  using  fresh  apron  and  towels  daily.  Soiled  linen  should 
be  removed  from  the  butcher  shop.  Clothing  and  personal  effects 
should  not  be  stored  therein,  nor  should  sleeping  in  the  butcher  shop 
be  tolerated. 

Hot  running  water  should  be  provided  in  order  that  instruments 
and  hands  may  be  washed  frequently.  Persons  having  injured  or  sore 
hands  should  report  at  once  to  the  medical  officer  and  should  be  relieved 
from  duty  in  the  butcher  shop  until  well.  Loafing  in  the  butcher  shop 
and  unnecessary  traffic  through  it  should  not  be  allowed.  Pets  should 
be  prohibited. 

The  Laundry. — The  laundry  on  board  ship  usually  is  under  the 
supervision  of  a  commissioned  officer  who  is  responsible  to  the  captain 
for  its  efficiency  and  for  the  execution  of  sanitary  recommendations 
made  by  the  medical  officer. 

The  medical  officer  should  inspect  the  laundry  frequently,  making 
unexpected  visits,  and  base  his  recommendations  upon  his  observations. 

The  laundrymen  should  be  clean  of  person  and  clothing,  and  should 
be  inspected  by  the  medical  officer  weekly.  Disease  carriers  should 
not  be  permitted  to  handle  laundry.  Sleeping  in  the  laundry  should 
not  be  permitted.  Loafing  should  not  be  allowed  and  no  unauthorized 
persons  should  be  permitted  to  work  in  the  laundry.  Sickness  among 
the  laundrymen  should  be  reported  promptly  to  the  medical  officer. 
Food,  insects  and  pets  have  no  place  in  the  laundry. 

Linen  from  the  sick  bay  should  be  carefully  disinfected  before  being 
sent  to  the  laundry  and  a  certificate  to  that  effect  signed  by  the  medical 
officer  or  pharmacist  should  accompany  it.  The  medical  officer  should 
prevent  the  sending  of  linen  to  the  laundry  by  any  person  known  to 
suffer  from  contagious  or  infectious  disease  until  the  washing  has  been 
disinfected.  In  so  far  as  practicable  the  soiled  linen  should  not  be 
permitted  to  come  in  contact  with  fresh  linen,  and  never  should  it  be 
stowed  in  the  laundry,  but  linen  to  the  capacity  of  the  laundry  should 
be  received  at  a  definite  hour,  after  which  no  soiled  linen  should  be 
received  until  that  already  in  the  laundry  has  been  washed,  ironed  and 
delivered.  The  receipt  of  washing  should  be  so  arranged  that  all  linen 
in  the  laundry  at  any  one  time  in  so  far  as  possible  should  come  from 
the  same  part  of  the  ship.  For  instance,  the  washing  of  all  officers 
should  be  taken  on  Monday  and  delivered  before  any  other  washing  is 
received.  Then  linen  from  another  section  of  the  ship  should  be  taken, 
laundered,  and  delivered.  This  method  will  tend  to  limit  dissemina- 


PARTS    OF    THE    SHIP    AND    HEALTH  211 

n   of   bed    bugs,   vermin  and   disease  throughout  the  ship.     The 
ndry  is  a  potent  factor  for  the  spread  of  disease  and  vermin,  being 
focus  to  which  they  may  be  carried  in  the  soiled  linen;  particularly 
/;/  may  be  distributed  from  this  focus. 

The  apparatus  should  be  of  the  latest,  most  approved  sanitary 
and  should  include  a  steam  drying  tumbler.     The  deck  should  be 
tile   or   similar   impervious,    non-absorbent  material.     The  walls 
uld  be  white  and  the  standing  parts  of  the  machinery  should  be 
inted  white.     The  white  paint  on  the  standing  parts  enables  the  more 
dy  detection  of  dirt  and  also  increases  the  amount  of  light  in  the 
rk  corners. 

The  laundry,  especially  if  between  decks,  should  be  provided  with 
efficient  exhaust  system  of  ventilation  for  the  removal  of  wild  heat 
d  excessive  humidity  incident  upon  the  laundering  processes. 
Distilled  or  approved  fresh  water  should  be  used  in  the  laundry, 
d  the  apparatus  should  be  thoroughly  washed  from  time  to  time  to 
vent  the  accumulation  of  precipitated  soap,  epithelium,  etc.  The 
laundry  should  be  thoroughly  cleaned  once  each  week,  and  gross  dirt 
r-hould  be  removed  daily. 

When  necessary  to  prevent  breeding  and  spread  of  vermin  or  to 
it  the  spread  of  communicable  diseases,  fumigation  of  the  laundry 
uld  be  practised. 

Underwear  and  bedding,  unless  made  of  wool,  should  be  submerged 
boiling  water  for  a  period  of  at  least  five  minutes.  Laundry  water 
uld  not  contain  a  sufficient  amount  of  lye  to  be  harmful  to  the  fabric. 
lorine  water,  which  is  surreptitiously  used  for  bleaching  purposes, 
uld  not  be  permitted  in  the  laundry  because  of  its  damaging  effect 
n  articles  bleached  by  it. 

It  is  a  common  habit  among  laundrymen  to  sprinkle  clothing  before 
ning  it  by  taking  water  into  the  mouth  and  spewing  it  over  the  gar- 
nt  to  be  ironed.     This  pernicious  habit  should  not  be  tolerated, 
appropriate  spraying  apparatus  should  be  provided  and  its  use 
uircd. 

A  rose  spray  at  tarried  to  a  large  rubber  l>ulb  similar  to  that  used  in 
florists'  shops  for  sprinkling  flowers  is  the  best  method.     An  ordinary 

k  broom  dipped  in  water  may  he  used. 

The  "sprinkling  can'1  frequently  used  is  mentioned  to  condemn  it. 
'his  can  has  a  spout  with  a  rose  spray  on  its  end  and  a  second  spout 


nons 

,,,,. 


212  NAVAL  HYGIENE 

or  mouth-piece  through  which  the  laundryman  may  blow  into  the  can 
and  force  water  out  through  the  first-mentioned  spout. 

Infection  of  the  clothes  may  result  from  saliva  which  entering  the 
water  may  be  sprayed  upon  a  garment  after  it  has  been  exposed  to  the 
heat  of  the  laundry  and  drying  processes. 

It  has  been  shown  that  the  brief  exposure  to  heat  during  the  ironing 
does  not  sterilize  infected  fabric,  but  Schroeder  and  Sutherland  (Public 
Health  Reports,  1917,  vol.  32,  p.  225)  have  shown  that  wet  clothes 
infected  with  bacteria  are  generally  sterile 
after  passing  through  tumblers,  mangles,  dry- 
ing rooms,  and  hot  pressing  or  ironing. 

Care  is  to  be  exercised  that  the  mass  of 
soiled  linen  is  in  the  water  sufficiently  long  to 
permit  penetration  of  the  boiling  water  to  the 
center  of  the  mass  of  clothing. 

Steam  laundries  are  far  more  sanitary  than 
hand  laundries.  Towels  in  daily  use  by  men 
on  board  ship  often  are  not  properly  dried  be- 
cause of  lack  of  proper  and  convenient  clothes 
lines.  Clothes  lines  should  be  conveniently 
placed  in  order  that  the  damp  towels  may  not 
be  stowed  away. 

Members    of    the    crew    frequently    wash 
their  own   clothing  in  the  wash  room  or  on 
FIG.  65. — A  rose  spray  deck   in   galvanized   iron   buckets.     Clothing 
used  by  florists  makes  an  thus  washed   should   be   carefully   dried,  and 

excellent     instrument    for 

sprinkling.  the  water  used  by  one  man  should  not  be 

used  by  a  second  for  the  washing  of  the  clothes 

of  the  latter.  The  soapy  fresh  water  in  the  bucket  may  be  used  by 
several  men  unless  effort  is  made  to  instruct  members  of  the  crew 
concerning  the  danger  of  this  violation  of  hygienic  laws. 

The  clothing  should  be  dried  in  the  sun  when  this  is  practicable 
because  of  the  bactericidal  effect  of  sunlight.  This  method  of  drying 
however  is  usually  impracticable  and  recourse  must  be  had  to  the  steam 
drying  room,  or  preferably  the  drying  tumbler. 

The  Steering  Engine  Room. — The  steering  engine  room  situated 
in  the  after-part  of  the  ship  and  well  below  the  water-line  is  uncomfort- 
ably hot  and  humid  when  steam  is  on  the  steering  engine.  This  com- 
partment is  lighted  artificially  and  those  whose  duties  keep  them  in  the 


PARTS  OF  THE  SHIP  AND  HEALTH  213 

ering  engine  room  should  be  required  to  spend  as  much  time  as 

sible  in  the  light  and  air  on  deck. 

Steering  engines  driven  by  electricity  are  far  less  reliable,  conse- 
quently steam  must  be  used  despite  the  discomfort  resulting.  Close 
watch  should  be  kept  upon  the  physical  condition  of  the  steering  engine 
crew  who  work  under  enervating  conditions  which  predispose  to  colds. 
XITVOUS  persons  should  not  be  allowed  to  go  on  this  duty  since  the 
noise  is  great  at  times  and  commences  with  startling  suddenness. 

Coaling  Ship. — Coaling  ship  is  disagreeable  and  dangerous.  It 
disagreeable  because  all  of  the  living  spaces  must  be  made  as  nearly 
-tight  as  possible  with  a  view  to  prevent  entrance  of  the  cloud  of 

1  dust  in  which  the  ship  is  enveloped  during  coaling.  Ventilation 
interfered  with.  There  is  disturbance  of  the  regular  routine,  and 

1  dust  is  everywhere. 

When  possible  coaling  is  usually  begun  just  so  soon  as  daylight 
will  enable  operation  of  the  machinery,  and  the  process  is  continued 
often  late  into  the  night  in  order  to  complete  the  coaling  in  a  single 

I  ay. 
The  deck  spaces  are  cluttered  with  piles  of  coal  and  the  gangways 
arc-  tilled  with  processions  of  black-faced  men  trundling  wheel  barrows 
en  with  coal.     In  threading  one's  way  about  on  deck  coal  dust  is 
to  lie  so  much  as  an  inch  deep,  and  the  nasal  and  respiratory  mucosa 
well  as  conjunctiva  are  much  irritated  by  the  cloud  of  coal  dust. 
Coaling    ship   is  dangerous  because  powerful  machinery  carrying 
vy  loads  are  handled  at  top  speed  in  order  to  complete  the  dis- 
able task.     Coal  is  hoisted  from  colliers  in  bags  containing  a  half 
each.     One-  load  from  a  single  cargo  boom  consists  of  5  bags  or  2  '  •> 
s.     The  contents  of  these  bags  are  dumped  on  the  deck  about  the 
uth  of  the  cylindrical  coal  chutes  and  groups  of  grimy  men  shovel  the 
1  rapidly  into  the  chutes,  trying  to  clear  the  deck  before  the  arrival 
another  j'^-ton  load.     As  these  heavy  loads  of  coal  swing  through 
air,  the  careless  man  or  the  heedless  one  may  be  struck  as  the  load 
ings  round.     Serious  injuries  occur  in  this  manner,  especially  toward 
end  of  the  day  when  the  men  are  tired. 

The  manipulation  of  the  machinery  ha<  it<  dangers  and  the  sky- 
er or  Careless  man  is  apt  to  injure-  or  he  injured. 

ur  th«-  <.»aling  in  the  early  morning  or  at  night  accidents  occur 
result  of  men  walking  into  the  mouths  of  the  chutes  through  which 
coal  is  being  shoveled.     The  mouths  of  these  chutes  are  generally 


214  NAVAL   HYGIENE 

marked  when  the  manhole  plates  are  off,  but  the  accidents  are  apt  to 
occur  in  the  half  light  when  the  markings  are  not  readily  seen. 

At  the  bottom  of  the  chute  the  coal  is  received  into  the  bunkers 
and  is  "  trimmed."  If  the  lumps  are  large  the  trimmers  may  be  injured 
as  result  of  the  lumps  falling  15  or  more  feet  and  striking  them.  The 
work  of  the  trimmers  is  very  arduous.  They  have  little  ventilation 
in  the  bunkers  and  an  ever-diminishing  volume  of  air  as  the  bunker 
fills  with  coal.  Such  air  as  is  available  is  heavily  laden  with  coal  dust. 

During  coaling  all  hands  are  required  to  remain  on  board.  Before 
coaling  commences  the  medical  officer  should  see  that  as  many  first- 
aid  parties  as  he  may  deem  advisable  are  stationed  in  accessible  posi- 
tions on  deck.  The  hospital  corpsman  in  charge  of  each  party  should 
have  stretcher,  tourniquet,  and  first-aid  dressing  ready  for  immediate 
work.  At  least  one  medical  officer  should  remain  below  decks  and  keep 
as  clean  as  possible  in  order  to  be  ready  to  operate  at  once  in  cases  of 
grave  injury.  The  operating  room  should  be  supplied  with  an  abun- 
dance of  dressings  prepared  for  emergency. 

The  commissary  department  should  supply  meals  as  nearly  on  time 
as  possible,  and  if  the  coaling  is  begun  in  the  early  morning  hot  coffee 
should  be  served  before  commencing.  As  coaling  is  very  laborious 
additional  rations  should  be  provided. 

The  playing  of  the  band  at  frequent  intervals  is  desirable  for  its 
psychological  effect  upon  the  workers. 

Medical  officers  should  watch  the  men  to  prevent  undue  exposure. 
In  winter  or  in  rainy  weather  men  coaling  ship  frequently  are  insuffi- 
ciently clad.  Not  desiring  to  ruin  good  clothing  for  which  they  have 
paid,  they  tend  to  dress  in  as  few  clothes  as  possible,  and  easily  become 
chilled  as  they  are  often  drenched  with  perspiration  during  work. 

After  coaling  ship  an  abundance  of  fresh  warm  water  should  be 
available  to  the  men  who  must  commence  at  once  to  scrub  the  ship 
inside  and  out.  It  takes  a  day  or  two  before  the  ship  is  clean  once  more. 

Conjunctivitis,  irritation  of  the  respiratory  mucosa,  cuts,  and 
bruises  remain  to  be  treated  by  the  medical  officer. 

" Coaling  ship"  is  a  very  simple  matter  on  vessels  using  fuel  oil. 
The  turning  of  a  valve  permits  the  oil  to  run  into  the  tanks  and  the 
arduous  labor,  dirt  and  discomfort  of  coaling  are  avoided.  Precaution 
should  be  taken  to  avoid  fire  while  handling  oil. 

Small  Boats  and  Boating.-  -Attendant  upon  large  ships  are  a  number 
of  small  boats.  These  vary  in  size  and  character  from  the  ungainly 


PARTS  OF  THE  SHIP  AND  HEALTH 


215 


flat-bottomed  punt  propelled  by  a  single  scull  which  is  used  by  the 
side  cleaners  or  men  working  on  the  ship's  side  near  the  water  level,  to 
e  picket  boat  or  large,  swift,  steam  launch.  Many  of  the  ship's 
ts  are  driven  by  gasolene  motors,  some  of  these  motor  boats  being 
ciently  large  to  carry  100  to  120  men.  The  ship's  boats  are 
isted  on  board  by  powerful  cranes,  and  when  possible  are  nested 
thin  one  another  in  cradles,  a  canvas  cover  being  lashed  over  all 
to  protect  them  from  the  weather.  Frequently  members  of  the  crews 


Fit,.   (.'>.      Repairing  targets  is  a  dangerous  phase  of  small  boating.     Frequently 
£l  hea.  inning,  men  fall  overboard  or  are  otherwise  injured.     They  should 

good  swimmers.      Much  exposure  is  involved  in  this  work. 

ihr-e  boats,   which  are  lying  in  the  cradles,  live  in  their  boats  in 
-eference  to  occupying  the  billets  assigned  to  them  between  decks, 
the  boats   they  are  well  protected  from  the  wind,  and  are  in  the 
•sh    air.   although    there   i-    no    heat    if    the  weather  is  cold.      These 
•n.  if  occupying  gasolene  motor  boats,  may  suffer  from  inhalation  of 
>lene   fume-   due   to  leakage  from  the  gasolene  tank.     The  fumes 
iv  he  confined   within   the  boat,  under  its  canvas  cover,  and  may 


2l6 


NAVAL  HYGIENE 


attain  concentration  sufficient  to  produce  gasolene  "jag."  I  have 
seen  two  fires  which  originated  from  explosions  caused  by  the  striking 
of  matches  within  a  boat  lying  in  the  cradles. 

Inspection  of  the  nested  boats  should  be  careful  and  thorough,  for 
the  seclusion  afforded  by  the  boats  enables  their  occupants  to  indulge 
in  harmful  practices  if  they  are  so  inclined. 

When  ship's  boats  are  in  the  water  their  crews  often  suffer  consider- 
able exposure  to  heat,  cold  and  wetting,  and  in  heavy  seas  there  is 
danger  of  the  foundering  of  small  boats  and  drowning  of  occupants. 


•M 


FIG.  67. — Spreading  targets. 

The  members  of  the  boat's  crew  should  be  expert  swimmers,  as  they 
are  not  infrequently  overboard,  accidentally  or  by  intent,  as  for  in- 
stance when  going  over  to  clear  a  fouled  propeller.  Members  of^the 
boat's  crew  should  be  provided  with  rain  clothes  and  should  be  warmly 
clad  for  protection  against  winter  weather.  In  summer  and  in  the 
tropics,  the  boat's  awnings  should  be  spread  between  the  hours  of 
9  :oo  a.m.  and  5  :oo  p.m.  for  protection  against  the  direct  rays  of  sun. 
Running  boats'  crews  often  suffer  as  a  result  of  irregular  meal  hours 
and  lack  of  opportunity  to  answer  the  calls  of  nature.  Observation 


PARTS    OF    THE    SHIP   AND   HEALTH 


217 


the  writer  to  believe  that  the  members  of  the  boats'  crews  have 
ifficient  time  to  eat. 

When  mess  gear  is  sounded,  even  if  the  boat  is  at  the  boom  one  or 
•e  members  of  the  crew  must  remain  in  it  as  boat  keepers  while  the 


FH;.  68. — A  Jacob's  ladder.     Pendant  is  ommitted  from  illustration. 

uro  aboard  to  eat  a  hurried  meal.     Having  eaten  they  ret  urn  to 
u-  boat   and  relieve  tluxr  who  have  l>een  left   behind  who  in  turn  go 
their  mess.     Tlnsc  two  groups  of  men  from  the  boat's  crew  eat  their 
s  (lurini:  a  >ingle  mess  period — that  is.  two  men  eat  in  succession 


218 


NAVAL   HYGIENE 


during  the  time  allotted  for  the  meal  of  one  individual.  Boating  at 
times  is  very  hard  work,  and  entails  a  maximum  of  effort  and  muscle 
strain,  as  for  instance  when  a  bow  man  tries  against  tide  and  wind  to 
hold  on  to  the  ship's  side,  with  his  boat  hook.  Hernia  is  apt  to  be  pro- 
duced as  result  of  such  strain.  When  boats  are  hauled  out  to  the  boom 
and  are  there  made  fast  there  is  often  considerable  danger  to  the  mem- 
bers of  the  crew  as  they  attempt  to  leave  the  lurching  boat,  going  over 


FIG.   69. — Swimmers  going  up  the  Jacob's  ladder  and  standing  on  the  boom. 

the  Jacob's  ladder  and  boom  to  reach  the  ship.  Considerable  danger 
also  attends  the  transfer  of  heavy  stores  from  the  boat  to  the  ship. 
Often  these  stores  are  placed  in  a  cargo  net  and  hoisted  vertically  out 
of  the  boat  to  be  swung  inboard  on  to  the  deck.  Should  the  cargo 
net  give  way  its  load  would  be  precipitated  upon  the  boat  below. 
While  attached  to  the  U.  S.  S.  Arkansas  at  Guantanamo  Bay,  1  treated 
a  man  who  was  injured  as  a  result  of  accident  to  the  hoisting  apparatus. 
He  was  struck  by  a  hind  quarter  of  frozen  beef  which  fell  from  .a  distance 


PARTS    OF    THE    SHIP    AND    HEALTH 


219 


not  less  than  20  feet,  fracturing  his  femur  and  producing  severe 
juries  about  the  head  and  face. 

Boats  leaving  the  ship  always  should  be  provided  with  a  supply 
[  fresh  drinking  water  in  a  " breaker"  or  keg  and  tinned  biscuit.     In 
tilling  boats,  and  especially  race  boats,  hernia  may  be  produced  by 
straining  at  the  oars.     In  patrol  and  picket  boats,  especially  the  no- 
foot  patrol  boats,  exposure  during  the  winter  is  extremely  severe.     The 
methods  of  heating  these  small  vessels  are  impracticable  and  much 
suffering  is  experienced  by  those  engaged  in  the  patrol  work. 


nt    may    happen    as   result    of   the   gunwale   of  the   boat   being 
?ht  under  the  accommodation  ladder.      Xote  the  bow  man  "holding  on"  with  a 

hook. 

One  ha>  ID  SIT  the>e  small  craft  covered  with  ice  coming  in  from  a 
of  duty  and   bringing  in   an  exhausted  crew  to  reali/e  the  hard- 
of  this  patriotic  service, 
Finally,  a   word   must  In-  >aid  concerning  the  danger  of  crushing 
ween    boats    and    gangways    or    tloats    alongside  which    the    boats 
ay  be  making  a  landing.     The  boats  carry  weigh  or  momentum  far 

than  is  rcali/ed  by  a  landsman,  and  the  novice  at   boatin. 
apt  to  get  finders  rrushed  or  hu  crated,  or  an  arm  or  a  foot  crushed, 
ling   to  clear   the  gunwale  as  a   boat    comes  alongside;  alx». 
A  a\.  the  small  boat  rising  and  falling  with  the-  >ea  may  crush 
leg  of    an  individual  who  attempts  to   jump  from  the  small  boat 


220  NAVAL   HYGIENE 

to  the  landing  stage,  as  the  boat  goes  down  from  the  crest  of  a  passing 
wave. 

Ship's  boats  should  not  be  overcrowded  in  going  to  and  from  the 
ship,  and  especially  should  care  be  exercised  to  see  that  liberty  parties 
returning  from  the  beach  trim  the  boat  so  that  the  weight  will  be  prop- 
erly distributed  throughout. 

Serious  accidents  have  resulted  from  the  improper  loading  of  small 
boats,  men  heedlessly  rushing  down  into  the  boat  and  paying  no  atten- 
tion whatever  to  the  trim. 

When  the  boat  heads  out  from  smooth  water  and  strikes  the  sea, 
it  may  overturn  and  life  may  be  lost.  During  coaling  and  occasionally 
at  other  times,  small  boats  may  be  sent  away  from  the  ship  to  remain 
overnight  at  a  dock  or  inshore.  The  medical  officer  should  see  that 
the  crews  of  such  boats  are  provided  with  food,  water,  proper  covering, 
and  if  in  a  locality  where  mosquitoes  are  prevalent,  mosquito  nettings 
should  not  be  forgotten. 

The  side  cleaners  who  work  in  punts  alongside  the  ship  often  are 
exposed  to  wetting  and  chilling,  their  clothes  and  shoes  becoming 
thoroughly  wet.  Rubber  boots  may  be  worn  and  the  clothing  should 
be  changed  at  the  earliest  opportunity. 

When  the  boats  are  being  "hooked  on"  to  be  hoisted  on  board  ship 
there  is  often  much  danger  to  those  who  are  attending  to  the  work, 
especially  those  in  the  boats.  Formerly  this  hoisting  was  done  by 
hand;  now  it  is  done  principally  by  large  cranes  operated  by  elec- 
tricity. As  the  small  boat  comes  alongside  to  be  hoisted  aboard  unless 
care  is  exercised  it  may  be  dashed  against  the  ship's  side  with  danger 
to  life  and  the  boat  as  well.  Also,  the  hoisting  tackle  is  heavy  and 
unless  it  is  dextrously  handled  and  the  hoisting  is  commenced  quickly, 
one  end  of  the  boat  may  be  raised,  while  the  fall  on  the  other  end, 
not  having  been  caught  in  the  ringbolts,  fails  to  hoist.  When  hoist- 
ing is  done  by  hand  one  end  of  the  boat  may  be  raised  more  slowly 
than  the  other  as  the  groups  of  men  manning  the  two  falls  vie  with 
each  other  in  hoisting.  If  a  fall  carries  away,  boat  and  occupants 
may  be  precipitated  into  the  water  with  serious  result.  An  accident 
of  this  character  happened  on  board  the  ship  to  which  I  was  attached 
in  the  harbor  at  Colon.  The  occupants  of  the  boat  were  thrown  into 
the  sea.  No  lives  were  lost,  but  serious  injury  followed  their  being 
struck  as  they  fell.  At  sea  it  often  becomes  necessary  for  a  big  ship 
to  maneuver  for  a  lee  in  order  to  enable  one  of  her  small  boats  to 


PARTS  OF  THE  SHIP  AND  HEALTH 


221 


hook  on.     When  boats  are  to  be  hoisted  a  minimum  number  of  men 
-ury  to  hook  on  should  be  permitted  to  remain  in  the  boat,  all 
others  should  be  sent  aboard.     In  steam  launches  burns  and  injuries 


;IG.  71. — Hoisting  a  big  forty-foot  steam  launch  from  the  water  into  its  cradles 

on  deck. 

frequently  occur,  as  for  instance  the  blowing  out  of  gauge  glass, 
scalding,  or  burning  while  handling  the  fires  when  the  boat  is  in  a 
seaway. 


222 


NAVAL  HYGIENE 


Bedding. — On  board  ship  the  crew  sleeps  in  the  hammocks  made  of 
canvas  suspended  from  hooks  on  the  deck  beams  by  means  of  ham- 
mock clews.  In  the  hammock  is  a  mattress  made  of  kapok,  a  highly 
inflammable  vegetable  substance,  the  best  of  which  is  obtained  from 
Ceiba  pentendra,  a  tree  grown  in  Java. 

Kapok  is  very  light  and  on  account  of  its  buoyancy  may  be  used 
as  a  life  preserver  as  well  as  for  a  mattress.  This  mattress  is  covered 


FIG.   72. — A  hammock  rolled  and  lashed.     A  hammock  spread.     A  hammock 
and  clothing  bag  securely  lashed  together  for  transport. 

by  a  cotton  mattress  cover  having  reinforced  felled  seams.  The  mat-  j 
tress  slips  into  the  cover  which  is  tied  together  at  one  end  with  tapes.  I 
The  mattress  cover  being  washable  serves  to  protect  the  mattress  as  j 
sheets  are  not  used.  Woolen  blankets  are  used  as  covering. 

Upon  arising  in  the  morning  the  hammock  is  rolled  into  a  neat  roll.] 
securely  lashed  and  stowed  in  the  hammock  nettings.  The  latter*- 
should  be  made  of  steel  and  all  cracks  should  be  thoroughly  illed  tc  j 


PARTS    OF    THE    SHIP    AND    HEALTH 


223 


prevent  the-  harboring  of  vermin.     Wood  should  not  be  used  in  the 
hammock  nettings. 

The  ship's  routine  requires  that  the  bedding  be  aired  Friday  of 
each  week,  the  weather  permitting.  When  the  hammocks  are  brought 
out  to  be  aired  they  should  be  unlashed  and  unrolled,  so  that  sunlight 
and  fresh  air  may  have  access  to  the  contents.  Frequently  the  weather 
will  not  allow  the  airing  of  bedding  according  to  schedule  and  the 


FK.  ping  on  billets  in  hammocks. 

medical  officer  should  be  vigilant  to  see  that  this  important  sanitary 
measure  is  carried  out  at  first  opportunity.  The  medical  officer 
should  see  that  the  divisional  officers  are  thoroughly  instructed  how  to 
in>pect  the  bedding  of  their  men. 

When  the  bedding  is  being  aired  it   should   be  inspected  for  the 
presence  of  vermin.     The  seams  and  tufting  of  the  mattresses  should 
be  thoroughly  examined  for  the  presence  of  bed  bugs  as  evidenced  by 
Hiding  of  the  bugs  themselves  or  the  stains  left  by  them.     Mat- 
tresses should  be  selected  at  random  for  examination. 


224 


NAVAL  HYGIENE 


Mattress  covers  should  be  changed  weekly.  The  engineer's  force 
should  give  special  attention  to  mattress  covers.  These  men  perform 
arduous  labor  under  conditions  of  dirt  and  grease,  and  their  mattress 
covers  are  apt  to  be  soiled  sooner  than  those  of  the  deck  force.  Dis- 
covery of  the  presence  of  vermin  should  be  the  signal  for  drastic  action. 


FIG.  74. — A  hammock   and  mattress   properly   secured  on   a  life  line   during 
"airing  bedding."     A  clothes  line  above. 

At  times  the  airing  of  bedding  is  impracticable  because  the  direction 
of  the  wind  is  such  that  cinders  from  the  smoke  pipe  are  deposited  on 
the  mattresses  and  blankets,  soiling  them  and  often  burning  if  the  draft 
from  the  smoke  pipe  is  very  great. 

The  hammocks  are  quite  comfortable.     Occasionally  an  individual 


PARTS  OF  THE  SHIP  AND  HEALTH 


225 


FIG.  75. — Airing  bedding. 


,  76. —  Section  of  the  rail  of  a  hammock  netting.  The  interval  formed  as 
rosult  of  warping  of  the  wood  forms  a  breeding  place  for  vermin.  The  author 
recommends  a  bare  steel  rail  without  the  wood. 

15 


226 


NAVAL  HYGIENE 


is  found  who  claims  inability  to  sleep  in 
a  hammock  but  this  is  infrequent. 

Accidents  occur  to  sleepers  in  ham- 
mocks as  result  of  the  cutting  of  the 
hammock  clews  by  a  practical  joker. 
This  precipitates  the  sleeper  to  the  deck 
and  he  is  fortunate  to  escape  without 
broken  bones. 

The  mattresses  should  be  kept  from 
the  deck  as  much  as  possible  in  order  to 
avoid  soiling. 

Baths. — Cold  baths  are  tonic  and 
stimulating.  Hot  baths  are  diaphoretic 
and  sedative.  Aside  from  the  therapeutic 
effects  of  baths  they  are  desirable: 

(a)  For  promotion  of  cleanliness; 

(b)  For    maintenance   of    the   skin's 
function; 

(c)  The  prevention  of  the  breeding  of 
germs  on  the  skin; 

(d)  Avoidance  of  air  pollution  due  to 
decomposition    of    excretions    from   the 
skin. 

Before  going  into  battle  all  hands 
should  take  a  bath  and  put  on  clean 
underclothing,  when  practicable. 

Abundant  bathing  facilities  should 
be  provided  on  board  ship  for  the  crew; 
shower  baths  in  proportion  of  one  shower 
per  25  men,  should  be  provided.  Tub 
baths  are  insanitary  and  should  not  be 
allowed. 

The  fire-room  force  usually  is  pro- 
vided sufficiently  with  bathing  facilities 
in  the  engineer's  wash  room,  but  the  deck 
force  has  not  been  equally  fortunate. 

FIG.  77.— Fresh  and  salt  water  The  latter  have  been  Compelled  to  de- 
shower  bath  with  an  instantaneous  d  iargeiy  upon  such  sponge  baths  as 
heater  attached.  Careless  ma-  * 

nipulation  may  result  in  scalding,  may   be  had   by  using   a  deck  bucket. 


DRAIN- 


PARTS  OF  THE  SHIP  AND  HEALTH  227 

ese  buckets   made  of  galvanized  iron  will   hold  ^  gallons.     Some 
wers  generally  are  provided  for  the  deck  force,  hut  the  number 
inadequate. 

The  Engineer's  Wash  Room. — The  engineer's  wash  room  is  usually 
ated  immediately  above  the  fire  room  so  that  coal  passers  and  firemen 
drenched  with  perspiration  and  covered  with  coal  dust  (on  coal-burning 
ships)  may  ascend  directly  from  their  stations,  bathe,  and  wash  out 
eir  steaming  clothes  before  going  out  on  deck.     This  arrangement 
ents  the  soiling  of  the  ship  which  would  result  were  the  wash  rooms 
tely  situated. 

The  location  of  the  wash  room  necessitates  being  placed  between 
ks  and  inboard  so  that  the  sun  does  not  get  to  it  to  dry  and  light 
Artificial  illumination  constantly  is  necessary,  and  unless  there  is 
lul  supervision  foul  odors  will  arise  from  decomposition  of  waste 

•oducts  resulting  from  baths. 
Each  member  of  the  engineer's  force  has  a  locker  in  which  steaming 
)thes  are  kept.     Unless  regularly  inspected,  foul  clothes  may  be 
permitted  to  remain  in  the  lockers  and  vitiate  the  air  by  their  odor. 
These  lockers  should  be  made  of  strong  galvanized  iron  wire  grating. 
This  enables  thorough  ventilation  and  facilitates  inspection. 

The  engineer's  wash  room  should  be  divjded  into  two  parts,  each 
being  used  on  alternate  days  while  the  other  is  being  thoroughly 
cleaned. 

To  prevent  the  spread  of  parasitic  skin  diseases,  common  use  of 
els  should  not  be  permitted,  and  a  steam  hose  should  be  used  freely 
to  spray  over  the  tile  floor  and  wooden  gratings  which  sometimes  are 
1  in  the  show* 

In  the  engineer's  wash  rooms  the  wooden  gratings  are  difficult 
to  keep  clean  and  -hould  he  steamed  daily.  The  drain  from  the  wash 
room  should  be  blown  out  with  the  steam  hose  daily  to  prevent  the 
had  odor  which  lommonly  arises  from  this  waste  pipe. 

ne  but  Mandard  soaps  should  he  allowed.     The  writer  has  seen 
of  dermatitis  due  to   <  !  carbolic  acid   in  a  much 

rti>ed  >oap. 

In  favorable  circumstances  of  climate  and  water  much  sea  bathing 
is  clone  by  the  ship's  company  (see  Swimming). 

Refrigeration.     Refrigeration  is  neee.^ary  on  hoard  <hip  for: 

(a)  The  preservation  of  food; 

(b)  The  cooling  of  the  mai^a/ines; 


228  NAVAL   BYGIENE 

(c)  The  cooling  of  water  at  the  scuttle-butts; 

(d)  The  manufacture  of  ice. 

On  board  the  ships  of  our  navy  refrigeration  is  accomplished  by  ice 
machines  of  the  dense  air  type.  They  depend  upon  the  absorption 
of  heat  which  results  from  the  expansion  of  compressed  air  in  coils.  The 
ammonia  ice  machines  are  both  unsatisfactory  and  dangerous  for  use 
between  decks  on  board  ship. 

(a)  The  Preservation  of  Food.— Fresh  foods;  meat,  butter,  eggs, 
fish  and  the  like  are  preserved  in  well-insulated  chambers  lined  with 
galvanized  iron,  equipped  with  hooks,  shelves,  and  racks  for  stowing 
the  meats.  The  compressed  cold  air  is  led  through  pipes  or  "coils" 
through  these  chambers.  The  compressed  air  in  the  pipes  expanding 
rapidly  abstracts  heat  from  the  chamber  and  by  a  proper  regulation 
a  desired  temperature  may  be  maintained  constantly. 

In  the  chambers  where  meat  is  kept  a  temperature  below  32°F. 
is  maintained  and  the  meat  is  kept  frozen  stiff.  Such  a  chamber  must 
be  very  carefully  watched  as  a  failure  to  maintain  freezing  temperature 
will  permit  thawing  and  consequent  decomposition. 

Butter  should  be  kept  in  a  separate  chamber  where  it  may  not 
absorb  odors  from  surrounding  food  stuffs.     If  possible  eggs  should  be 
kept  in  a  chamber  in  which  the  temperature  is  35°  to  4o°F.  to  prevent 
their  freezing.     This  same  temperature  is  desirable  for  preservation 
of  fresh  fruits.     The  lining  of  the  chambers  should  be  water-tight, 
for  on  the  cooling  coils  even  in  the  tropics  a  constant  thick  woolly  * 
coat  of  snow  ice  is  deposited.    When  for  any  reason  the  temperature  j 
rises  sufficiently  to  permit  melting,  the  water  finds  its  way  through 
leaks  in  the  chamber,  gets  into  the  felt  insulation,  and  there  causes  j 
decomposition  and  insanitary  conditions. 

Meats,  fish,  and  shell-fish  may  be  kept  almost  indefinitely  if  tlu 
proper  temperatures  are  maintained.  The  writer  has  eaten  oysters 
frog  legs,  and  fowl  taken  from  cold  storage  after  they  had  been  kepi 
for  three  months.  The  articles  are  frozen  stiff  and  may  be  handlec 
as  one  would  so  much  wood. 

The  refrigerators  should  be  opened  not  more  than  twice  a  day  fo  J 
the  removal  of  stores.  If  opened  oftener  they  are  warmed  up  anc| 
injury  to  the  food  results.  The  persons  entering  the  ice-box  should  b  •! 
warmly  dressed  and  should  wear  clean  shoes,  preferably  rubber  over r 
shoes.  The  various  compartments  should  be  kept  swept  out  b  ' 


PARTS  OF  THE  SHIP  AND  HEALTH 


229 


>ms  used  for  no  other  purpose.  Unless  attention  is  paid  to  this 
>tail  much  frozen  filth  will  accumulate.  The  chambers  of  the  cold 
>rage  cannot  be  scrubbed  while  the  temperature  is  below  32°F. 
When  practicable,  for  instance  at  Navy  Yards,  the  cold  storage 
maid  be  emptied,  thoroughly  overhauled  and  scrubbed  with  lye  and 
>t  water,  then  rinsed  out  before  refilling. 

(b)  The  Cooling  of  the  Magazines. — In  order  to  prevent  deteriora- 
tion of  explosives  the  temperature  in  the  magazines  must  be  maintained 

a  certain  standard,  and  for  this  purpose  connection  is  made  with 
the  ice  machines. 

(c)  The  Cooling  of  Water  at  the  Scuttle  Butts.— Drinking  water 
the  crew  is  cooled  in  the  scuttle  butts  by  means  of  cooling  coils 

,-hich  pass  through  the  water  in  the  scuttle  butts. 

(d)  The  Production  of  Ice. — A  small  amount  of  ice  is  made  for  the 
ooling  of  water  in  the  officers'  and  chief  petty  officers'  messes,  for  the 

,mall  refrigerators  belonging  to  these  messes  and  for  the  sick  bay. 
riu«  amount  of  ice  manufactured  is  limited  to  actual  needs. 

Sewage  Disposal. — On  board  large  ships  the  disposal  of  human 
•\c  reta  is  a  comparatively  simple  problem,  yet  certain  things  still  are 
;o  be  desired  in  order  to  render  sanitary  the  disposal. 

The  "Heads"  or  Water  Closets.— On  large  ships  the  "heads" 
ire  located  above  the  water-line  and  discharge  overboard  through 
Irainage  pipes  and  scuppers. 

This  discharge  is  effected  through  the  medium  of  a  circulating 

>tem  in  which  salt  water  is  pumped  through  the  heads,  giving  a 
continuous  flow  in  the  fixtures  and  washing  away  by  gravity  the  excreta 
as  they  are  deposited.  The  lips  of  the  scuppers  should  be  sufficiently 
long  to  direct  the  sewage  away  from  the  ship's  side  as  it  falls  into  the 
r  in  which  the  ship  lie-.  The  mouth  of  the  scupper  should ^be 
•  ted  l»y  a  check  which  enables  sewage  to  escape,  but  is  closed 
automatically  when  the  mouth  of  the  scupper  is  struck  by  a 

Portable   canvas  chutes  or   "pantaloons"   reaching  down   to  the 

:   from  the  scuppers  arc-  ust-d  when  in  port  and  protect  the  ship's 

from   fouling.     The  lips  of  the  scuppers  should  be  kept  clean, 

else  objectionable  odor  may  he  noticed  on  board  ship  near  their  point 

ra  and  >hip'-  boats  should  avoid  coming  in 
range  of  the  discharge  from  the  scuppers. 

The  heads  for  the  crew  usually  are  situated  in  the  eyes  of  the  ship 


230 


NAVAL   HYGIENE 


under  the  forecastle,  unless  the  wardroom  is  located  forward,  in  which 
case  the  crew's  heads  are  aft. 

The  heads  should  have  a  tile  deck  and  should  contain  no  wood 
except  necessary  floor  gratings  and  the  seats. 


FIG.  78. — Scuppers.  Sewage  is  being  discharged  from  the  one  on  the  right 
and  spatters  or  is  blown  by  the  wind.  On  the  left  a  portable  canvas  pantaloon 
enables  discharge  at  the  water  level. 

The  heads  should  be  sufficiently  large  to  enable  division  inio  two 
halves,  each  half  being  in  use  by  the  crew  while  the  opposite  half  is 
being  cleaned  and  prepared  for  the  next  day's  use. 

Accommodations  should  be  provided  for  10  per  cent,  of  the  crew  un- 


PARTS  OF  THE  SHIP  AND  HEALTH  231 

urinals  are  to  be  provided  in  addition.  In  this  case  one  urinal 
lould  be  provided  for  each  15  men.  Of  the  10  per  cent.,  5  per 
it.  should  be  in  daily  use  while  the  other  5  per  cent,  are  being 

led,  e.  #.,  a  battle  ship  having  1200  men  should  be  provided  with 

seats,  60  of  which  are  in  use  while  the  remaining  60  are  being 
•aned.  Greater  privacy  is  desirable  in  the  crew's  heads.  Screens 

u>ed  but  they  interfere: 

1.  With  ventilation; 

2.  With  cleaning; 

With  careful  inspection;  and, 
4.  They  afford  opportunity  for  pernicious  practices. 

Wat  IT  closets  should  be  ventilated  thoroughly  by  the  exhaust  sys- 
em,  and  automatically  flushed. 

Space,  weight,  cost  and  simplicity  have  determined  that  the  best 
ype  of  fixture  for  the  crew's  head  is  a  trough  of  appropriate  size  made 
f  porcelain  or  tin-lined  iron  or  of  plain  cast  iron  gently  pitched  to  the 
te  pipe  and  through  which  a  stream  of  salt  water  is  constantly  being 
ushed.  This  trough  may  be  used  as  a  urinal  and  when  the  seats 
re  in  place  may  he  used  for  defecation.  The  trough  should  be  so 
iaped  that  fee  es  will  not  fall  on  and  adhere  to  its  sides. 

The  best  type  of  seat  is  that  which  is  divided  into  two  distinct 

ulves,  being  split  in  the  middle  in  front  and  behind,  each  half  is  hinged 

>  that  it  may  l>e  raised  if  the  individual  does  not  desire  to  sit  upon  it. 

"I  he  halves  >hould  be  removable  and  should  be  unpainted.     Dressed 

ash  is  the  l>e-t  wood  for  the  purpose.     The  seats  should  be  taken  off 

during  the  day  for  cleaning,  sprayed  with  a  steam  hose  and  thoroughly 

scrubbed.     The  spraying   with   a   steam   hose  is  for   the  purpose  of 

k.'.lling  microorganisms  which  may  have  soiled  them  or  killing  vermin 

if  >uch  cxiM. 

After  considerable  experience  the  writer  is  sceptical  as  to  the  alleged 
frequency  with  which  pediculi  are  contracted  in  water  closets.  On 
inspections  he  ha>  never  seen  a  louse  on  a  water-closet  seat,  and  it  is 
doubtful  if  a  srli"-re>pecting  louse  would  desert  board  and  lodging  for 
an  inhospitable  water-closet  seat. 

During  theproc  ess  of  cleaning  t  he  <t  earn  hose  should  also  be  sprayed 
i  In   trough.     Seats  which  ked  are  insanitary  and  should 

be  removed  at.  once. 

The  medical  officer  should  keep  in  touch  with  the  captain  of  the 


232 


NAVAL  HYGIENE 


head,  and  carefully  instruct  him  as  to  the  great  importance  of  his 
duties.  The  captain  of  the  head,  if  properly  approached  may  be  able 
to  give  the  medical  officer  valuable  information  concerning  concealed 
disease  or  vicious  habits  observed  or  suspected  by  him  in  the  perfor- 
mance of  his  duties. 


12- 


FIG.  79. — A,  A  transverse  section  of  C,  the  trough  over  which  water-closet  seats 
are  placed.     B,  detailed  drawing  of  water-closet  seat. 

An  abundance  of  toilet  paper  should  always  be  at  hand  and  no 
ships'  head  should  be  constructed  which  does  not  include  a  lavatory 
with  foot  or  knee  controlled  faucets  at  which  soiled  hands  may  be  rinsed 
before  leaving  the  closet  to  handle  door  knobs,  hand  rails,  etc.  Bibu- 
lous paper  towels  should  be  supplied. 


PARTS  OF  THE  SHIP  AND  HEALTH 


233 


I  A  lean  mentions  the  case  of  a  forecastle  hand  who  was  a  typhoid 
carrier  to  whom  13  cases  of  typhoid  were  traced  as  result  of  the 
common  use  of  a  vertical  ladder,  the  carrier  being  careless  in  cleaning 
his  hands  after  visiting  the  water  closet. 

The  water  closets  for  the  officers  should  be  well  ventilated,  provided 
with  toilets  automatically  flushed,  or  of  the  pump  type,  and  porcelain 


F i<;.   80. — A  pump  type  water  closet  used  in  the  officers'  toilet. 

urinals.  The  toilets  should  have  porcelain  howl  with  varnished  hard- 
wood seats  and  should  he  so  constructed  as  to  prevent  the  soiling  of 
the  u-rr  hy  n-ijuriiitat ion  of  air  and  water  when  the  ship  pitch, 
rolls,  and  the  mouth  of  the  -cupper  suddenly  becomes  submerged. 
The  floor  -hould  he  tiled  and  the  space  alloted  for  each  separate 
toilet  should  be  sufficiently  large  to  prevent  constrained  positions. 


234 


NAVAL  HYGIENE 


All  water-closet  seats  should  be  as  low  as  cleanliness  will  permit. 
The  base  on  which  the  feet  of  the  occupant  rest  should  be  not  more 
than  6  inches  below  the  level  of  the  toilet  seat.  This  approximates 
more  nearly  the  natural  position  and  enables  compression  of  the  ab- 
domen against  the  thighs  to  aid  in  expulsive  effort. 


FIG.   8 1. — Scupper  connected  with  sewer  as  the  ship  lies  in  dry  dock. 

Constipation  is  very  prevalent  among  seafaring  population,  and 
one  of  the  factors  is  believed  to  be  the  inhibiting  effect  resulting  from 
muscle  effort  expended  in  balancing  on  a  too  high  toilet  seat,  when  the 
ship  is  having  a  good  deal  of  motion. 


PARTS   OF  THE   SHIP  AND  HEALTH 


235 


tin  small  craft  whose  water  closets  are  on  or  below  the  water  level 
rater  closet  of  the  pump  variety  must  be  employed.     These  closets 
difficult  to  keep  in  order.     The  Hermes  sewage  ejector  serves  a 
purpose  somewhat  similar  to  that  of  the  pump  closet.     Sewage  accu- 
mulates in  a  tank  which  communicates  by  means  of  a  valve  with  the 
outside  of  the  ship,  and  at  given  times  is  expelled  by  an  automatic 
application  of  steam  pressure. 

A  crew  of  1200  men  will  excrete  600  pounds  of  feces  and  nearly 
4000  pounds  of  urine  daily.     The  disposal  of  this  and  other  sewage 
>mes  a  problem  when  ships  are  in  dry  dock. 


FIG.   82. — A  man-of-war  ready  to  enter  a  drydnck. 


In  .sum-  dry  ducks  connection  with  sewer  mains  are  impossible, 
rrmit  the  sewage  from  the  ship  to  discharge  into  the  dry  dock 
would  be  insanitary.  If  connection  cannot  be  made  with  a  sewer 
the  water  closets  and  baths  on  the  ship  must  be  closed  and  officers  and 
men  must  avail  themselves  of  water-closet  facilities  to  be  found  near  the 
dp-  dock.  This  is  uncomfortable,  especially  during  inclement  weather. 

In  tlu  be-t -equipped  dry  docks  arrangements  are  made  whereby 
the  ship's  waste  pipes  may  be  connected  directly  with  sewer  mains 
running  alongside  the  dock.  This  connection  enables  the  use  of  the 


236 


NAVAL  HYGIENE 


FIG.  83. — Flooding  the  drydock  preliminary  to  floating  in  a  big  ship. 


FIG.  84. — A  man-of-war  in  the  drydock.  The  dock  has  been  pumped  dry,  the 
vessel  has  settled  on  the  keel  blocks  and  is  shored  on  each  side  by  heavy  timber!-: 
which  support  her  on  an  even  keel. 


PARTS  OF  THE  SHIP  AND  HEALTH  237 

iter  closets  and  contributes  greatly  to  the  comfort  of  those  who  must 
•emain  on  board  ship  while  she  is  in  dry  dock.  (Fig.  i.) 

Under  Repair. — Ships  undergoing  prolonged  repairs  at  Navy  Yards 

not  fit  for  human  habitation. 

The  filth  incident  upon  the  repair  work;  the  invasion  by  a  horde  of 
)rkmen,  many  of  whom  are  filthy  of  habit  and  spit  anywhere;  the 
cluttering  of  the  ship  with  materials  for  repair;  the  noise  of  the  chipping 
hammer;  the  odor  of  fresh  paint;  the  noise  made  by  the  operation 
of  pneumatic  tools,  improper  heating  in  winter;  difficult  garbage  dis- 
1 :  and  often  the  necessity  for  visiting  a  water  closet  on  the  dock 
iir  all  kinds  of  weather  day  and  night  when  sewer  connections 
cannot  be  made  are  some  of  the  discomforts.  Barracks  should 
1  «.  provided  at  Navy  Yards  to  which  the  crews  of  ships  undergoing 
r. -pairs  may  be  transferred.  Here  the  men  could  live  in  sankary  and 
c  mifortable  surroundings  until  the  repair  work  is  completed,  leaving 
only  enough  men  on  board  to  guard  and  police  the  ship. 

Garbage  Disposal. — Considerable  garbage  and  refuse  accumulates 
on  board  ship  as  the  result  of  the  activities  of  its  personnel. 

At  sea  some  of  the  refuse  may  be  dumped  overboard  through  the 

•  chute. 

Jn  time  of  war  this  cannot  be  done  because  of  the  possibility  that 
it  may  give  an  enemy  the  clue  to  the  ship's  whereabouts.  Tin  cans 
must  have  their  bottoms  perforated,  so  they  will  sink  immediately 
if  thrown  overboard,  and  the  wood  from  boxes  and  crates  must  be 
burned. 

A  reiu^-  and  garbage  incinerator  should  be  installed  on  every  big 
ship.  The  dry  refuse,  e.g.,  boxes,  paper,  etc.,  may  be  used  for  the  dry- 
ing and  burning  of  that  which  is  wet.  The  incinerator  should  be 
connected  with  the  ship's  smoke  pipe  in  order  that  odors,  gases,  and 
smoke  may  be  conducted  away  from  the  decks. 

Hut  for  the  fouling  of  harbors  and  the  possibility  of  giving  informa- 
tion to  an  enemy  during  war  the  problem  of  conservancy  would  be  a 
simple  one,  readily  soluble-  by  the  simple  expedient  of  dumping  every- 
thing overboard. 

During  prolonged  overhaul  a  >hip  may  lie  alongside  a  dock  for 
>omc-  time,  and  in  the  absence  of  an  effective  incinerator  the  garbage 
n.ust  he  disposed  of  by  contract  as  is  done  in  our  cities. 

While  the  garbage  is  being  collected  between  the  calls  of  the  garbage 
wagons  it  should  be  placed  in  covered  galvanized  iron  garbage  cans 


238 


NAVAL  HYGIENE 


SLOP  CHUTE. 


FIG.  85. — Bell's  flushing  garbage  chute  for  use  aboard  ship. 


PARTS  OF  THE  SHIP  AND  HEALTH 


239 


Canvas  /4/>ron.    70  6e 
footed  en  before  use 


'..  86. — Bell's  garbage  bin  made  of  tongued  and  grooved  lumber,  lined  with 
tin,  and  or.   wli-  ^m-d  to  hold  a  24-hour  accumulation  of  garbage    until 

;il  of  a  garbage  lighter.      For  use  in  harbors. 


240 


NAVAL  HYGIENE 


having  four  perforations  in  the  bottom  of  each  to  enable  the  draining 
away  of  the  fluid  portion  of  the  garbage. 

These  cans  should  be  placed  inside  a  fly-proof  garbage  bin  con- 
structed of  lumber  sufficiently  strong  to  withstand  wind  and  covered 
preferably  with  copper  wire  cloth,  sixteen  strands  to  the  inch.  This 


FIG.  87. — Fly-proof  garbage  receiver  for  use  when  the  ship  is  alongside  the 
dock.     The  drain  is  shown  in  the  upper  left  hand  corner. 

garbage  house  should  be  entered  through  two  doors  between  which 
interposed  a  vestibule  6  feet  long,  thus  enabling  the  entrance  to 
bin  without  direct  communication  with  the  exterior.  For  durabi] 
the  lower  part  of  the  walls  should  be  made  of  wood  to  a  height  oi 
feet  above  the  floor  surface.  It  should  be  fly-proof.  The  wire  cl( 


PARTS  OF  THE  SHIP  AND  HEALTH  241 

lould  cover  the  remainder  of  the  walls  and  roof.     A  shallow  gently 
itched  groove  should  be  placed  in  the  concrete  floor  to  drain  away 
ic  fluid  portion  of  the  garbage  as  it  drips  from  the  perforated  cans. 
'his  groove  should  terminate  in  a  lip  which  extends  over  the  edge 
cf  the  dock,  thereby  enabling  direct  drainage  into  the  harbor.     This 
t'y-proof  bin  should  be  located  close  to  a  hydrant,  so  that  the  floor 
of  the  bin  may  be  flushed  down  daily  and  the  garbage  cans  may  be 
washed  after  the  garbage  has  been  collected  from  them.     The  above- 
-ibed  fly-proof  bin  was  found  most  satisfactory  by  the  writer  on 
the  U.  S.  S.  North  Dakota. 

Bill  of  Materials  for  Fly-proof  Garbage  Receiver 

2 it)        sq.  ft.  tongneu  and  grooved  pine  sheathing  (dressed) 
2"  X  4"-    6'io"long  (studs) 

4  2"  X  4"  -  22' o"  long  (plate  and  sill) 
2"  X  4"  -  ii 'o"  long  (plate  and  sill) 

5  2"  X  4"  -  n'o"  long  (ceiling  joints) 

12  2"  X  4"       3's"  l°ng  (intermediate  rails) 

4  2"  X  4"-     3 '9"  long. (intermediate  rails) 

3  2"  X  4"--    3V'  l°ng  (intermediate  rails) 
530  :t.  wire  screening 

2  ven  doors,  2'6"  X  6'io" 

32V'  of  screen  door  stop  J£"  X  2" 

121  cu.  ft.  of  concrete,  1-2-4  mixture 

of  enclosure— ii 'o"  X  22'©" 

On  small  craft  the  disposal  of  garbage  is  not  so  easy.  Moist  garbage 
cannot  be  burned  in  the  lire  room  because  it  has  been  found  to  burn 
poorly,  with  the  result  that  it  tends  to  bank  if  not  extinguish  the  fires. 


1C 


CHAPTER  XV 
FACILITIES  FOR  CARE  OF  THE  SICK  ON  BOARD  SHIP 

The  Sick  Bay  is  the  Ship's  Hospital.— The  office  of  the  medical 
officer  should  contain  a  large  desk  for  clerical  work;  a  sink  with  knee 
control  and  hot  and  cold  water;  a  locker  for  microscope,  incubator, 
and  bacteriological  outfit;  and  should  be  conveniently  arranged  so 
that  sick  call  may  be  held  in  this  office  rather  than  in  the  sick  bay, 
where  patients  would  be  annoyed  by  the  noise  and  bustle  incident 
upon  sick  call.  This  office  likewise  should  be  large  enough  so  that 
anti-typhoid  prophylaxis  may  be  administered  and  vaccinations  and 
examinations  for  enlistment,  discharge  and  transfer  may  take  place. 

The  Dispensary. — The  dispensary  should  have  appropriate  shelves, 
bottle  racks  and  drawers  for  holding  medicines  and  dressings  in  a  con- 
venient manner.  Desks  should  be  provided  at  which  clerical  work 
may  be  performed,  and  the  dispensary  should  contain  a  bunk  for  the 
chief  pharmacist's  mate,  who  should  be  available  at  all  times  in  case  of 
emergency. 

The  Ward. — The  sick  bay  on  a  battleship  should  occupy  a  position 
on  the  second  deck,  so  that  it  will  be  easily  accessible  from  the  main 
deck ;  should  be  sufficiently  above  water  to  permit  air-ports  to  remain 
open  a  maximum  of  time,  and  should  be  so  far  as  possible  removed 
from  the  noise  incident  upon  the  anchor  engine  and  hawse  pipe  forward, 
and  from  the  engine  room  aft.  If  practicable  it  is  desirable  that  the  | 
sick  bay  should  extend  the  full  breadth  of  the  ship  in  order  that  a  maxi- 
mum of  natural  ventilation  may  be  attained. 

The  bunk  facilities  should  be  provided  in  proportion  of  about  2^ 
per  cent,  of  the  complement.     In  emergency  this  will  be  found  wholly 
inadequate,  but  in  normal  circumstances  it  will  be  sufficient.     The 
bunks  should  be  of  the  double-deck  type  which  may  be  swung  up  when  • 
not  occupied. 

Lighting. — All  electric  lights  should  be  covered  with  opal  glas 
fixtures  or  other  method  of  indirect  illumination,  so  that  the  bai 
filaments  may  not  be  exposed  to  the  eyes  of  those  in  bed.  Light 

242 


FACILITIES   FOR    CARE    OF    SICK   ON  BOARD    SHIP 


243 


ould  be  conveniently  placed  so  that  those  occupying  bunks  may 
or  may  hi-  examined  as  necessity  may  require. 

e  deck  should  be  covered  with  battle-ship  linoleum  and  should 
pitched  so  as  to  drain  in  case  the  deck  is  flooded.     The  interior  of 
sick  bay  should  be  painted  greenish  yellow,  barely  off  white,  as  this 


..   88. — Tb-  office  and  examinin.  :\  small  la! 

d   and   bacteriological  work.      Note   the   electric    incubator  i.n  the 
id  to  the  left  of  the  microscope  and  desk. 

und  more  restful  to  the  eyes  and  reduces  glare.     All  furniture 
should  be  of  s'< 

:lalion.     An  air  supply  of  400  cubic  feet  per  bunk  should  be 
ided  with  necessary  change  of  air  by  mean>  of  artificial  ventilating 


244 


NAVAL  HYGIENE 


system.  Artificial  ventilation  should  take  place  by  means  of  supply 
and  exhaust  systems  combined,  and  so  operating  as  to  make  a  slight 
excess  pressure  in  the  sick  bay.  The  louvers  should  be  so  located  as  to 
secure  thorough  distribution  of  the  air  supplied.  Commonly  the 
ventilation  and  heating  are  combined  in  the  thermo-heating  system 


FIG.  89. — The  dispensary  is  fitted  with  bottle  racks  holding  individual -bottles  to  pre- 
vent breakage  in  heavy  weather.     The  drawers  and  cabinets  are  made  of  steel. 

which  supplies  hot  air.  This  system  is  not  satisfactory.  The  vital 
quality  or  "freshness  "  of  the  air  is  lost  by  parching  before  it  is  delivered 
to  patients.  The  sick  bay  should  be  heated  by  high-pressure  steam- 
heating  system,  independent  of  the  ventilating  system. 

Steel  lockers  having  perforated  doors  for  purpose  of  ventilation 


FACILITIES    FOR    CARE    OF    SICK    ON  BOARD    SHIP 


245 


an  1  inspection  should  be  provided  for  the  storing  of  the  clothing  and 
effects  of  patients.  Suitable  racks  or  closets  should  be  provided  for 
stretchers  and  a  closet  or  locker  for  stowing  cleaning  gear  is  necessary. 
A  dressing  table  which  may  be  swung  up  when  not  in  use  is  very  useful. 
This  table  should  be  located  near  the  wash  basins  where  hot  and  cold 
running  water  should  be  supplied,  and  where  a  large  sink  also  should 
be  installed.  (Fig.  95.) 


the  double-deck  folding  cots. 

locker  fur  hospital  furniture  and  surgical  appliances  should 
be  provided  as  should  a  drug  and  poison  locker. 

Bathroom.-  The  bathroom  should  be  painted  white  inside,  well 
lighted,  thoroughly  ventilated  by  an  exhaust  louver  and  have  a  deck 
of  ceramic  tiling  pitched  to  a  drain  in  an  outer  corner.  This  room 
should  contain  one  -hower  hath,  one  tub  bath  and  two  toilets.  The 
batht'iV  -hould  be  porcelain  lined  and  supplied  with  hot  and  cold  water. 
Tlu-  shower  should  he  supplied  with  an  instantaneous  heater  which 
should  be  carefully  supervised  to  prevent  the  scalding  of  patients  who 


246 


NAVAL    HYGIENE 


do  not  understand  its  manipulation.  The  shower  bath  should  be  used 
whenever  it  is  practicable,  but  there  are  circumstances  when  the  tub 
bath  is  indispensable,  for  instance  in  the  treatment  of  cramps  in  men 
from  the  fire  room. 

A  waste  sink  should  be  placed  in  the  bathroom  also.  This  should 
be  porcelain  lined.  The  toilet  seats  should  be  of  hard  wood  painted 
with  white  enamel  paint  in  order  that  they  may  be  thoroughly  cleaned 
and  disinfected,  and  the  basins  should  be  of  porcelain. 


FIG.   91. — The  operating  room.     Furniture  is  made  fast  to  the  deck. 

The  Operating  Room. — The  operating  room  on  board  a  battle- 
ship, while  compact  in  arrangement;  may  be  as  complete  as  the  large 
rooms  on  shore. 

The  deck  should  be  of  ceramic  tiling,  pitched  to  drain.  The  room 
should  be  painted  white  throughout.  The  ventilating  system  should 
be  the  supply  system,  and  the  louver  should  not  deliver  air  over  the 
operating  table.  The  electric  lighting  should  be  on  two  circuits  so 
that  if  one  fuse  should  blow  or  accident  should  happen  during  an  opera- 
tion the  second  circuit  may  be  available. 


FACILITIES    FOR    CARE    OF    SICK    ON   BOARD    SHIP 


247 


ie  operating  table  should  be  of  approved  type  of  stationary 
table,  having  glass  surface  and  appropriate  drainage.  The  frame- 
work of  the  table  should  be  painted  with  white  enamel  paint.  Dressing 
sterilizers,  instrument  sterilizers,  utensil  sterilizers  and  sterilizers  for 
hot  and  cold  water  should  be  provided.  Electrically  heated  sterilizers 
are  being  used. 


.        Thr 


h   basin,   water  supply,   and  toilet  enable 
complete  isolation  of  an  infectious  case. 


Thr  rack-  for  basins,  dressing  drums,  irrigating  bottles,  ligatures 
aid  siiture>  should  be  made  of  white  enamel  and  anchored  so  that  they 
m  iv  not  m-t  adrift  in  a  seaway.  Stationary  wash  basins  should  be 
provided  with  hot  and  cold  water  and  should  have  foot  or  knee 
control.  Tin-  waste  -ink  should  be  similarly  supplied.  The  operating 
room  should  be  made  as  nearly  dust  proof  as  possible  and  the  air 
supplied  should  be  tillered. 

Isolation  Ward.  The  isolation  ward  should  contain  at  least  four 
bi.nks,  double-banked:  should  have  ceramic  tiled  Moor;  should  be  lighted 
ard  heated  just  as  the  main  sick  bay,  and  should  be  ventilated  by  a 


248 


NAVAL  HYGIENE 


separate  supply  and  exhaust.  It  should  have  an  air  space  of  800  cubic 
feet  per  capita.  The  isolation  ward  on  board  ship  should  be  supplied 
with  a  separate  water  closet,  otherwise  complete  isolation  of  infectious 
diseases  is  impracticable,  as  was  seen  on  the  U.  S.  S.  Ohio  during  the 
small -pox  outbreak  some  years  ago. 


FIG.  93. — The   dentist's   office   is   well   equipped   with   modern   apparatus  and 

instruments. 

A  room  should  be  installed  for  venereal  and  prophylactic  treatments. 

An  office  for  the  dentist  containing  a  dental  chair,  equipment, 
instrument  cabinet,  hot  and  cold  running  water  with  knee  or  foot 
control,  and  desk  for  clerical  work,  should  be  supplied. 

Storeroom. — The  medical  storeroom  should  be  located  in  the  hold 
of  the  ship  and  should  be  as  cool  as  practicable.  Certain  drugs  dete- 


FACILITIES   FOR   CARE    OF   SICK   ON  BOARD    SHIP 


249 


riorate  rapidly  when  exposed  to  heat.  It  is  a  common  experience  to 
find  ampules  of  amyl  nitrite  have  exploded  in  their  original  wrappers 
in  the  storeroom. 

The  storeroom  should  be  well  lighted  and  ventilated.  It  should 
be  as  nearly  dust  proof  as  possible  for  the  protection  of  surgical  dressings 
and  hospital  equipment. 

The  bulkheads  and  all  shelves  should  be  painted  white.  White 
paint  aids  the  inspecting  officer.  Dirt  on  it  is  easy  to  see.  The  shelves 
should  be  of  sheet  metal  as  protection  against  fire. 

Battle  Dressing  Stations. — Battle  dressing  stations  on  board  battle- 
ships should  be  located  fore  and  aft  behind  the  armor  belt.  In  action 
it  becomes  necessary  to  evacuate  the  sick  bay  and  place  the  activities 


. — Covered  sink  and  wash  basin  in  a  battle  dressing  station, 
metal  covers  prevent  unauthorized  use  of  these  fixtures. 


Locked 


of  the  medical  depart  merit  in  a  less  exposed  position.  Each  battle 
<lr :^<\ng  station  should  be  provided  with  hot  and  cold  running  water, 
led  to  wash  basins  and  a  waste  sink. 

Steel  lockers  for  emergency  surgical  dressings  should  be  provided, 
and  if  practicable  the  medical  storeroom  should  be  close  to  and  easily 
accessible  from  the  main  dressing  station.  The  waste  from  the  battle 
dressing  stations  should  communicate  with  the  ship's  drainage.  Abun- 
dant light  should  be  provided  for  all  portions  of  each  battle  dressing 
station,  and  it  should  be  on  two  circuits  from  different  sources  if  possible. 

There  should  be  supplied  sufficient  light,  with  a  reflector,  to  enable 
tli«.-  performance  of  nece»arv  surgical  work.  A  large  gravity  tank 
should  supply  the  necessary  water.  This  tank  should  be  behind  armor 
and  should  be  tilled  before  going  into  battle.  A  sanitary  scuttle  butt 
>h»uld  be  installed. 


250 


NAVAL   HYGIENE 


It  should  be  remembered  that  in  time  of  stress  facilities  for  the  dis- 
posal of  excreta  will  be  needed  and  should  be  provided  in  the  shape  of 
pump  closets,  possibly  communicating  with  the  ash  ejector! 

Steel  tables  which  may  be  swung  up  when  not  in  use  should  be 
placed  on  the  bulkheads  near  to  the  side  selected  for  the  operating 
table.  These  may  be  utilized  for  dressing  tables  or  tables  for  basins. 

Sufficient  number  of  clean,  new  swabs  should  be  kept  in  the  dressing 
station  lockers  for  emergency  use,  and  stretchers  likewise  should  be 


\ 


FIG.  95. — Folding  table.     When  not  in  use  it  is  folded  back  against  the  bulk- 
head.    A  useful  dressing  table. 

provided.  Connections  for  electrical  sterilizers  and  electrical  heaters 
for  preparing  special  diets  likewise  should  be  installed. 

The  surgical  equipment  from  the  main  operating  room  should  be 
moved  to  the  principal  dressing  station,  and  a  portable  operating  table 
may  be  supplied  for  the  second  battle  dressing  station. 

Preliminary  to  going  in  action  sterile  solutions  of  morphia  should 
be  made  up  in  quantity,  and  placed  in  vials  covered  with  sterile  rubber 
dam,  through  which  a  sterile  needle  of  a  hypodermic  syringe  quicily 


FACILITIES   FOR   CARE    OF    SICK   ON  BOARD   SHIP  251 


hrr.  transferring  a  man  fnmi  a  ship  to  a  small 
boat. 


252  NAVAL   HYGIENE 

may  be  thrust  to  charge  the  syringe  after  the  dam  has  been  wiped  off 
with  gauze  or  cotton  saturated  with  alcohol. 

The  question  of  air  supply  in  battle  dressing  stations  is  a  difficult 
one  in  time  of  action  as  probably  the  blowers  will  be  shut  down,  and  it 
will  be  necessary  to  depend  upon  such  air  as  may  be  in  the  station 
at  the  time  of  engagement. 


FIG.  97. — The  stretcher  chair  used  for  transporting  wounded  in  the  German 


navy 


Transportation  of  Sick  and  Injured  on  Board  Ship.— -There  are 
many  locations  on  board  ship  in  which  sick  or  injured  men  must  be 
man  handled  because  of  their  inaccessibility.  This  handling  should  be 
carefully  done  in  such  way  as  not  to  aggravate  the  injury.  The  pack 
saddle  is  a  very  effective  way  of  carrying  the  conscious  patient  who 
may  be  able  to  give  some  assistance  by  clinging  around  the  necks  of  his 


FACILITIES   FOR   CARE   OF    SICK   ON  BOARD    SHIP 


253 


bearers.  Where  only  one  person  is  available  the  problem  is  much 
complicated.  Help  should  be  sought  as  it  is  dangerous  for  one  man  to 
attempt  to  carry  an  unconscious  man  through  the  narrow  passages 
or  up  the  ladders.  Carrying  by  hand  is  the  most  generally  useful 
r  ict  hod  aboard  ship. 

Of  the  mechanical  appliances  used  for  the  transportation  of  sick 
or  wounded  the  Stokes  Splint  Stretcher  is  most  commonly  used  on 


,    <;S.       I.    A  nan  strapped  in  the  Stokes  splint  stretcher  used  in  the  United 
States  3,  the  Lung  apron  stretcher.     C,  the  hammock  stretcher  used  in 

German  N 


ird  ships  of  the  U.  S.  Navy.     It  is  a  galvanized  iron  stretcher-basket 
hich  has  certain   fixation  apparatus  attached  to  it.     These  consist 
n  straps  whirh  pass  over  the  patient's  chest,  hips  and  legs  as  he  lies 
n  the  wire  basket.     A  movable  foot  rest  is  provided  on  each  side  of  the 
jptum  which  divides  the  lower  end  of  the  basket  into  two  big  furrows 
for  the  legs  of  the  patient.     An  opening  is  provided  in  case  it  becomes 
iccessary   to  permit  the  stretcher  patient  to  use  the  bedpan.     There 
ire  hand  grips  around  the  strong  galvanized  iron  frame  which  forms  the 


254 


NAVAL  HYGIENE 


upper  margin  of  the  basket.  These  may  be  used  either  for  carrying 
the  stretcher  by  hand,  or  for  attaching  it  by  means  of  a  bridle  to  a 
hoisting  apparatus  for  lowering  to  or  hoisting  from  a  small  boat.  This 
splint  stretcher  is  very  useful  in  getting  men  out  of  small  spaces,  as 
when  the  patient  has  been  strapped  in  the  stretcher,  and  patient  may  be 
hoisted  to  a  vertical  position  and  raised  perpendicularly.  This  stretcher 
is  not  intended  for  field  use  as  it  is  too  heavy  and  too  expensive  for 
such  purpose.  It  is  without  equal  for  the  transportation  of  patient 


FIG.  99. — The  Neill  Robertson  stretcher  used  in  the  British  Navy.     It  is  made 
of  canvas  and  bamboo  strips  and  may  be  swung  as  a  hammock. 


from  ship  to  hospital  or  for  shipment  by  rail  of  patients  having  frac- 
tures. It  possesses  the  further  advantage  of  being  non-inflammable 
and  easily  disinfected. 

The  light  canvas  litter  used  by  the  U.  S.  Army  is  used  also  by  the 
medical  department  of  the  Navy,  but  it  generally  accompanies  landing 
forces,  as  it  is  lighter  than  the  Stokes  stretcher.  It  is  not  efficient  on 
board  ship  because  when  loaded  this  stretcher  cannot  be  handled  at 
hatches  or  going  from  one  deck  to  another  without  danger  of  the 
patient's  falling. 


A     i: 


FACILITIES   FOR   CARE   OF   SICK   ON  BOARD   SHIP 


255 


A  light  and  serviceable  stretcher  made  of  canvas,  stiffened  with 
bamboo  and  having  beckets  with  which  it  may  be  carried,  or  may  be 


ic.   100. — A,   The  stretcher  hammock.     (Guezennec.)     B,  the  Totsuka  stretcher 
used  in  the  Japanese  Navy.     (Surgeon-General  Braisted's  Report.) 


FIG.   1 01. — Patient     properly    placed    in    stretcher    on    a    small    boat.     The 
tied  outline  indicates  an  incorrect  position  from  which  the  stretcher  may  be 
pushed  as  the  boat  comes  alongside  a  float,  ship,  or  landing. 

suspended  vertically  when  the  patient  is  strapped  in  it  is  in  use  in  the 
British  Navy.     This  is  known  as  the  Neill  Robertson  stretcher  and 


256 


NAVAL   HYGIENE 


is  similar  to  the  Totsuka  stretcher  used  by  the  Japanese.  The 
Germans  employ  a  canvas  hammock  stretcher  into  which  the  men 
may  be  strapped  and  carried  by  beckets. 

The  Lung  apron  stretcher  devised  by  Medical  Director  Lung,  U.  S. 
N.,  consists  of  a  board  to  which  the  patient  may  be  strapped  by  means 
of  canvas  flaps  or  "aprons/'     There  are  beckets  to  enable  its  carrying 
or  suspension  in  vertical  position. 


CHAPTER  XVI 
RECRUITING 

The  careful  recruiting  officer  is  a  "watch-dog  of  the  Treasury." 
Upon  his  acumen  in  the  recognition  of  deformity,  disease,  or  vicious 
habit  depend  potential  pension  claims. 

None  but  experienced  officers  should  be  detailed  for  recruiting 
duty.  A  knowledge  of  service  requirements  is  necessary  to  enable  nice 
discrimination  in  border-line  cases  in  which  acceptance  of  the  individual 
may  incur  an  obligation  to  care  for  one  who  is  physically  unfit,  or 
rejection  of  the  individual  may  lose  for  the  country  the  services  of  an 
efficient,  willing  man. 

This  experience  likewise  will  enable  the  recruiting  officer  to  decide 
whether  a  man  is  physically  qualified  for  performance  of  duties  of  a 
given  rating:  e.g.,  X  may  be  small  of  stature  and  light  in  weight  and 
yet  make  a  good  radio  operator,  while  he  would  be  utterly  unfit  to  do 
the  heavy  work  required  of  a  coal-passer. 

A  moderate  myopia  may  almost  be  an  asset  to  a  ship's  writer,  or 
yeoman,  and  yet  totally  disqualify  a  candidate  for  gun  pointing. 

The  candidate  should  be  clean  and  sober  at  the  time  of  examination. 

SYSTEM  OF  EXAMINATION 

Unless  the  examiner  adopts  a  system  of  examination  he  may  be 
chagrined  by  being  asked  to  explain  why  he  passed  candidates  having 
disqualifying  defects.  Some  system  of  examination  should  be  adopted 
and  adhered  to  rigidly. 

I  have  found  it  most  satisfactory  to  take  a  cursory  general  view 
of  the  candidate  and  then  commence  a  careful  physical  examination, 
taking  head,  upper  extremities,  chest,  abdomen,  inguinal  and  perineal 
regions,  and  lower  extremities  in  the  order  named. 

Following  this  the  motion  of  the  principal  joints  of  the  body  is 
carefully  studied.  The  measurements  then  are  taken  and  the 
records  made. 

17  257 


258  NAVAL  HYGIENE 

Cursory  General  View. — In  the  cursory  general  view  of  the  stripped 
candidate  disqualifying  defects  such  as  lordosis,  ankylosis,  large  hernia, 
etc.,  may  be  evident  at  once.  Marked  stigmata  of  degeneration  should 
be  noted  and  any  personal  peculiarities  or  deformities  tending  to  make 
their  owner  a  butt  of  ridicule  by  his  fellows  should  cause  rejection. 

The  presence  of  obscene  devices  tattooed  on  the  skin  strongly 
suggests  a  sexual  pervert.  Burn  scars  may  indicate  an  epileptic. 

Pulmonary  tuberculosis  or  other  grave  constitutional  conditions 
as  well  as  possible  drug  addictions  may  suggest  themselves  in  this 
examination.  Skin  diseases  and  pediculosis  will  be  evident. 

During  this  examination  the  medical  officer  should  observe  as  far 
as  possible  the  quality  of  mind  possessed  by  the  applicant,  judging 
from  the  character  of  his  replies  and  the  intelligence  with  which  he 
executes  the  instructions  given  to  him  in  the  course  of  the  examination. 

The  tendency  of  the  candidate  desiring  to  enlist  will  be  to  minimize 
physical  defects,  which  subsequently  may  be  exaggerated  greatly  in 
the  desire  to  obtain  discharge  from  service  because  of  alleged  disability. 

The  examiner  invariably  should  question  the  candidate  as  to  whether 
he  has  recently  suffered  from: 

(a)  Fits  (epileptic  attacks,  etc.) ; 

(b)  Nocturnal  enuresis;  or. 

(c)  Concealed  disease  of  any  character. 

The  preparation  of  the  descriptive  list  should  be  made  not  as  the 
examiner  progresses,  but  at  the  completion  of  the  examination  when 
his  entire  attention  may  be  directed  to  this  important  feature  of  the 
work. 

Examination  of  the  Head. — The  head  should  be  examined  carefully 
for  lice  or  any  infectious  disease  of  the  skin,  for  marked  cranial  asym- 
metry, scars  or  depressions  which  might  suggest  previous  skull  injury, 
and  possible  cerebral  irritation.  At  this  time  also  the  glands  in  the 
cervical  triangles,  anterior  and  posterior,  should  be  examined. 

The  Eyes. — Absence  of  eyebrows  and  cilia  should  be  noted  as 
suggestive  of  syphilitic  infection.  The  lids  should  be  examined  for 
evidence  of  disease  and  any  purulent  discharge  in  the  conjunctiva! 
sac  should  lead  to  careful  examination  of  the  lacrimal  sac.  Marked 
strabismus  should  cause  rejection.  The  cornea  should  be  examined 
for  opacities  and  the  iris  should  be  clear  of  synechiae.  It  should 
respond  normally  to  light. 


RECRUITING  259 

lie  functional  examination  of  the  eye  consists  in: 

(a)  Determination  of  color  perception; 

(b)  Determination  of  visual  acuity; 

(c)  Special  examination  of  applicants  for  aviation  duty  (see 

page  267). 

(a)  Determination  of  color  perception  should  be  carefully  carried 
out.  It  should  be  remembered  that  limited  color  perception  may  be 
tolerated  in  certain  ratings,  but  in  most  ratings  in  the  navy  the  color 
perception  should  be  keen.  Perhaps  in  no  rank  or  rating  in  the  service 
should  the  requirements  in  respect  of  color  perception  be  more  rigid 
than  in  the  members  of  the  medical  corps  who  must  themselves  examine 
others.  More  than  2  per  cent,  of  all  applicants  for  the  naval  service 
were  rejected  during  1917  because  of  color  blindness. 

The  Holmgren  method  is  that  which  is  prescribed  by  Navy  Regu- 
lations. While  perhaps  this  method  is  best  adapted  for  all-round  use 
in  the  naval  service,  the  Jennings  method,  the  Edridge-Green  Lamp 
and  the  Thompson  Lamp  have  their  advantages  and  disadvantages. 

1'unctiomil  Examination. — (a)  Holmgren  Method. — In  this  method 
the  three  large  test  skeins  are  shown  to  the  candidate  in  a  definite 
order,  viz.,  light  green,  rose  pink,  and  red.  //  is  of  utmost  importance 
that  this  sequence  be  observed  invariably. 

The  large,  light  yellowish-green  skein  is  first  shown  and  the  candi- 
date is  required  to  place  beside  it  those  of  the  same  color  (but  not 
necessarily  of  the  same  shade)  from  the  pile  of  various  colored  skeins. 
This  test  alone  determines  whether  the  candidate  is  red  or  green  blind. 
Those  possessing  feeble  chromatic  sense  will  hesitate  while  normal 
color  perception  will  enable  the  candidate  to  select  the  skeins  promptly. 

The  color  blind  will  select  wrong  colors  of  about  the  same  shade. 
1  k-  may  put  a  light  blue,  light  purple,  light  green,  light  red,  or  even  a 
light  gray  all  in  the  same  pile  in  attempting  to  select  greens  to  go  with 
ilu  <jreen  test  skein.  If  he  selects  only  greens  his  color  perception  is 
normal.  If  with  the  green  he  selects  other  colors  he  is  "color  blind." 

He  now  should  be  shown  the  rose-pink  skein.  If  he  selects  skeins 
of  the  same  color  his  color  perception  is  normal.  His  performance  with 
the  i^rri-n  skdn>  is  corroborated.  But  if  he  has  been  shown  to  be 
"color  blind"  by  the  green  test  he  will: 

1.  Select  green  or  gray  and  place  it  with  the  rose-pink  test  skein;  or 

2.  Will  place  only  purple  with  it. 


260  NAVAL  HYGIENE 

In  the  first  case  he  is  completely  red-green  blind;  in  the  second  he  is 
partially  "color  blind." 

The  red  test  skein  should  now  be  shown  to  the  candidate.  If  he 
selects  the  shades  of  red  and  places  them  with  it  he  merely  corrobo- 
rates the  evidence  of  normal  color  sense  shown  in  handling  the  green 
and  rose-pink  test  skeins. 

If,  however,  he  has  been  shown  color  blind  by  the  two  tests  just 
described  he  will  make  characteristic  blunders,  viz.,  selection  of  dark 
greens  if  red  blind  and  selection  of  light  greens  if  green  blind. 

In  making  this  test  the  names  of  the  colors  should  not  be  mentioned. 
Many  persons  are  color  ignorant.  They  should  be  required  to  "select 
skeins  of  the  same  color,  light  or  dark,"  independently  of  their  names. 
This  gives  the  test  of  their  color  perception. 

Color  ignorance  is  as  important  as  color  blindness  from  a  practical 
viewpoint.  Consequently  after  the  examination  of  color  perception 
is  completed  the  names  of  the  several  primary  colors  invariably  should 
be  asked. 

The  lookout  who  misnames  colors  is  almost  as  dangerous  as  the 
man  who  cannot  see  them.  Where  a  large  number  of  men  are  to  be 
examined  time  will  be  saved  by  permitting  them  to  observe  the  exami- 
nation of  a  candidate.  They  will  then  understand  what  is  desired 
and  will  go  through  the  test  much  more  rapidly  than  if  instructed 
individually. 

It  is  a  good  plan  for  the  examiner  to  go  through  the  test,  showing 
just  what  is  required.  Such  procedure  will  give  little  or  no  aid  to  the 
color  blind  who  will  blunder  hopelessly  despite  the  demonstration. 

The  skeins  should  be  clean  and  should  be  kept  from  the  light  when 
not  actually  in  use.  They  fade  and  get  full  of  dust. 

(b)  The  Test  for  Visual  Acuity.— The  Grow  Unlearnable  Card  or 
the  Snellen  test  card  is  used,  the  former  being  better  adapted  to  service 
needs  despite  the  slight  disadvantage  that  the  patient  with  poor  vision 
must  approach  nearer  than  the  standard  test  distance  set  by  Snellen, 
viz.  20  feet. 

The  candidate  should  be  required  to  look  directly  at  the  exposed 
letters  with  his  uncovered  eye.  The  covered  eye  should  be  completely 
occluded  by  some  opaque  blinder  which  will  fit  snugly  in  front  of  the 
eye  and  permit  no  vision  in  the  covered  eye.  The  distance  from  the 
card  to  the  candidate  should  be  20  feet.  The  light  should  be 
good. 


RECRUITING  261 

The  vision  of  the  would-be  gun  pointers  should  be  tested  out  on 
deck  in  the  open,  under  conditions  which  have  to  be  met  in  target 
practice. 

Normal  vision  is  not  necessary  in  certain  ratings,  but  is  desirable  in 
all.  The  vision  of  the  store-keeper  need  not  be  so  acute  as  that  of  the 
gun  pointer.  V  =  20/20  B.  E.  is  required  for  the  gun  pointer,  whereas 

=  15/20  B.  E.  may  be  accepted  in  certain  other  ratings. 

The  Nose. — Deviated  or  perforated  septum,  hypertrophied  turbi- 
nates,  ozaena,  occlusion  of  one  nostril,  and  adenoids  should  be  in  mind 
during  the  examination.  If  the  candidate  closes  one  nostril  and  inspires 
forcibly  through  the  other  valuable  information  may  be  obtained. 

The  Mouth. — The  examiner  should  look  for  deformities,  or  scarring 
from  disease  (syphilis).  Mucous  patches,  tuberculous  ulcers,  Vincent's 
angina,  tumors,  or  deformities  should  be  evident.  Hypertrophied  or 
diseased  tonsils  should  lead  the  examiner  to  inquire  closely  for  history 
of  rheumatism,  or  of  diphtheria.  The  possibility  of  the  candidate 
being  a  " carrier"  should  be  in  mind. 

It  is  most  important  that  the  recruit  have  at  least  twenty  sound 
teeth.  Of  these  there  must  be  four  molars  and  four  incisors  which 
oppose. 

The  Ears. — The  ears  should  not  be  deformed  and  should  have  a 
normal  auditory  acuity  of  15/15  in  each  ear  for  the  spoken  voice,  and 
40  40  for  the  watch.  Complete  deafness  in  one  ear  is  cause  for  re- 
jection. The  examiner  should  see  the  membrana  tympani,  if  it  is 
present,  and  note  any  abnormality  about  it. 

In  testing  with  the  spoken  voice  the  examiner  of  experience  stands 
1 5  feet  from  the  candidate  and  whispers  in  a  low  tone  or  stage  whisper 
certain  phrases,  names  or  numbers,  and  asks  the  candidate  to  repeat 
sunn-,  indicating  that  he  has  or  has  not  heard.  , 

When  <c\  era!  persons  are  to  be  examined  it  may  be  found  convenient 
to  have  them  stand  facing  one  direction  on  a  line  at  right  angle  to  that 
i  pon  which  the  examiner  stands  facing  them.  Having  the  opposite 
ears  closed  they  listen  with  the  ears  exposed  to  the  examiner.  The 
surgeon  should  require  one  man  to  repeat  the  phrases  and  the  others  to 
hdicate  by  raising  their  bands  whether  they  have  heard.  Kach  man  in 
turn  should  lie  required  to  repeat  the  words,  the  others  indicating  by 
hand  that  they  have  heard. 

The  examiner  should  be  on  the  alert  to  di>co\rr  perforation  in  the 
tympanic  membrane  or  evidences  of  inflammation. 


262  NAVAL   HYGIENE 

In  testing  for  auditory  acuity  he  should  require  the  candidate  to 
keep  his  mouth  closed  during  the  test.  The  ear  opposite  to  that 
being  tested  should  be  thoroughly  closed  by  a  folded  towel  held  by  an 
assistant. 

The  Neck. — -The  neck  should  be  examined  for  glandular  disease 
(including  goiter)  and  for  deformities,  congenital  or  acquired. 

The  Arms  and  Hands. — The  arms  and  hands  should  show  no  loss 
or  deformity  of  any  part.  Ankylosis  of  a  joint  may  be  immediately 
evident,  but  may  not  be  recognized  until  the  systematic  examination  of 
joints  which  will  take  place  later.  The  stained  forefinger  of  the 
cigarette  smoker  should  attract  special  attention  to  the  heart.  The 
epitrochlear  glands  should  be  palpated  for  sign  of  enlargement. 

The  Chest. — The  examiner's  keenest  powers  of  observation  will  be 
taxed  to  the  utmost  in  examination  of  the  chest.  Deformities  such 
as  pigeon  breast  should  be  noted.  Auscultation  upon  which  so  much 
depends  often  may  be  next  to  impossible.  None  who  has  not  actually 
had  the  experience  can  realize  the  impossibility  of  making  a  careful 
physical  examination  aboard  ship  while  pneumatic  tools  and  chipping 
hammers  are  making"  their  infernal  clatter  upon  resonant  steel  plates 
nearby.  The  examiner  should  remember  that  the  hard  rubber  dia- 
phragm on  some  of  the  stethoscopes  in  the  market  may  give  sounds 
simulating  diseased  conditions. 

The  Lungs. — Departures  from  the  normal  vesicular  murmur  of 
healthy  lung  tissue  should  be  regarded  seriously.  Repeatedly  young 
candidates  who  have  had  a  tuberculous  history  have  been  told  to 
"take  a  sea  voyage"  and  present  themselves  for  enlistment.  History 
should  be  carefully  considered. 

If  tuberculosis  is  suspected,  reject.  Too  much  is  at  stake.  A  tuber- 
culous individual  is  in  too  intimate  contact  with  others  aboard  ship 
to  warrant  running  risk. 

In  each  case  the  examiner  should  satisfy  himself  of  the  presence 
of  normal  expansion  of  lung  tissue,  posteriorly  and  downward. 

The  Heart. — Examination  of  the  heart  should  be  conducted  care- 
fully and  in  accordance  with  usual  methods.  Marked  enlargement  or 
displacement  of  the  apex  beat  should  be  carefully  considered  and 
usually  the  candidate  should  be  rejected. 

It  is  believed  that  haemic,  cardio-respiratory  murmurs  and  pseudo- 
murmurs  caused  by  the  faulty  use  of  the  stethoscope  have  resulted 


RECRUITING  263 

in  rejection  of  individuals  having  sound  hearts  more  frequently  than 
commonly  is  realized. 

The  examiner  cannot  too  quickly  reject  an  applicant  because  of  an 
organic  murmur,  but  he  should  assure  himself  of  probable  organic 
origin  before  rejecting. 

Tachycardia  is  very  common  among  young  adult  cigarette  smokers, 
but  the  examiner  should  remember  it  is  one  of  the  early  signs  of  pul- 
monary tuberculosis,  or  may  indicate  an  exophthalmic  goiter.  Oppor- 
tunity should  be  given  for  the  candidate  to  recover  from  overexertion 
or  from  excitement.  .If,  then,  the  pulse  rate  exceeds  100,  reject. 

The  Abdomen. — The  examiner  should  examine  liver,  spleen,  appen- 
(\\\,  and  kidney  regions  for  evidence  of  disease.  The  umbilicus  should 
show  no  hernia.  The  applicant  should  be  questioned  carefully  for 
history  of  abdominal  disease. 

Inguinal  Region  and  Perineum. — The  examiner  should  exclude 
lice  and  venereal  disease.  He  should  require  the  applicant  to  strip  the 
urethra  thoroughly  for  evidence  of  gonorrhoea,  and  the  prepuce,  glans, 
and  frenum  should  be  closely  scrutinized  for  venereal  sores  or  scars. 

Varicocele,  hydrocele,  undescended  testes  and  hernia  should  be 
detected  if  present. 

Double  varicocele  should  be  cause  for  rejection.  Too  commonly 
lynph  leg  or  scrotum  results  from  the  disturbance  of  vessels  incident 
upon  bilateral  operation  for  varicocele. 

Patulous  inguinal  rings  are  apt  to  develop  into  hernia  under  the 
heavy  work  of  actual  service. 

The  anal  region  should  be  examined  for  evidence  of  disease.  An 
individual  possessing  a  markedly  patulous  anus  should  be  summarily 
ted. 

Lower  Extremities.  Deformities,  varimsities,  flat  foot,  hammer  toe, 
o\  erridin.tr  toe,  and  bunions  should  be  detected  by  the  examiner. 

Marked  varicose  veins  should  cause  rejection.  The  deep  veins  are 
probably  just  as  varicose  as  the  superficial  one-. 

Operation  is  the  only  remedy  for  hammer  toe.  The  examiner  should 
assure  himself  that  a  depressed  arch  actually  exists  before  rejecting 
an  applicant  for  flat  foot.  Too  commonly  the  error  is  made  of  diag- 
nosing a  well-developed  plantar  musculature  as  llat  foot.  Absence 
ot  either  jjrea!  '  ion. 

Examination  of  Joints.  Commencing  with  the  temporo-maxillary 
articulation,  the  vertebral,  shoulder,  elbow,  wrist,  phalangeal,  hip, 


264  NAVAL   HYGIENE 

knee,  ankle,  tarsal  and  phalangeal  joints  should  be  exercised  in  order. 
Limitation  of  motion,  ankylosis,  or  contracture  should  be  noted. 

Old  dislocations,  evidence  of  bone  disease,  or  joint  effusion  should 
not  escape  the  examiner. 

The  examiner  now  is  in  position  to  take  the  measurements  required 
and  to  dictate  for  record  the  descriptive  list  of  personal  characteristics. 

Measurements. — The  height  is  taken  by  having  the  applicant  stand 
without  shoes,  with  his  back  to  a  vertical  rod  or  plane,  at  right  angle 
to  which  is  lowered  a  ruler  or  moving  member  of  a  measuring  apparatus. 
It  should  barely  touch  the  scalp  as  the  head  is  moved  gently  from  one 
side  to  the  other. 

Chest  Measurements.—  A  tape  measure  around  the  bare  chest  at 
the  nipple  line  will  give  the  measurements  on  inspiration  and  expira- 
tion. The  difference  between  these  gives  the  chest  expansion  (provided 
the  well-recognized  muscle  trick  of  apparently  expanding  the  chest  is  not 
brought  into  play).  This  should  never  be  below  2^-2  inches.  Measure- 
ment of  the  chest  upon  inspiration  always  should  be  considered 
with  reference  to  measurements  taken  at  the  umbilicus  at  the  same 
time. 

Weight/ — The  nude  applicant  should  be  weighed  upon  previously 
balanced  scales. 

As  result  of  long  observation  a  standard  of  weight  for  height  has 
been  established  (see  Appendix)  and  experience  has  shown  the  folly 
of  departure  from  these  standards.  The  individual  who  is  below  the 
minimum  weight  for  his  height  probably  will  develop  pulmonary 
tuberculosis  if  the  disease  is  not  already  present. 

The  Descriptive  List. — The  examiner  should  exercise  great  care  in 
rilling  out  the  applicant's  descriptive  list.  Color  of  eyes  and  hair 
should  be  accurately  stated,  and  personal  peculiarities  should  be  noted. 
The  location  of  moles,  nevi,  tattoo  marks  and  scars  should  be  carefully 
noted  on  the  outline  figure  card.  These  with  the  finger  prints,  which 
are  taken,  give  accurate  data  for  indentification. 

Vaccination. — The  examination  of  the  applicant  should  not  be 
regarded  as  complete  until  he  has  been  vaccinated  and  has  received 
the  initial  dose  of  anti-typhoid  prophylactic. 

During  1917  the  principal  causes  of  rejection  of  persons  examined 
for  original  enlistment  in  the  U.  S.  Navy  were: 


^fraction 

Tnder   weight 

>efective  teeth  

Flat  or  weak  feet 

Deformities 

Varicose  veins  or  varicocele 

Under  height 

Heart  affections 

Color  perception  defective . 
Genito-urinary  (venereal) .  . 
Tuberculosis  or  suspects. .  . 


Navy 

5,36o 
4,507 
3.935 
3,534 
2,822 

2,33i 
1,623 

i,439 

i,352 

914 

657 


Marine 
Corps 

1,537 
890 

943 
i,494 
73i 
774 
501 
863 
363 
433 
252 


Naval 
Reserve 

2O 
7 
3 
3 
7 
3 

5 

2 
2 

2 


CHAPTER  XVII 
AVIATION 

Aviation  has  become  such  an  important  factor  in  military  and  naval 
operations  that  a  brief  consideration  of  it  is  warranted. 

Ability  to  attain  high  altitudes  is  desirable  in  time  of  war  for  the 
dual  purpose  of  avoiding  anti-aircraft  guns  and  preventing  discovery 
of  the  fliers.  An  officer  who  was  in  London  during  the  most  disastrous 
air  raid  against  that  city  states  that  owing  to  the  altitude  of  the  invad- 
ing machines  they  were  almost  invisible,  and  further  that  the  motors 
could  be  heard  scarcely,  if  at  all. 

Battle  planes  are  righting  now  at  an  altitude  of  19,000  to  20,000 
feet. 

Since  air  pressure  diminishes  fairly  rapidly  as  distance  above  the 
earth's  surface  increases,  vertical  ascents  must  be  limited  to  a  distance 
of  from  2^  to  3^  miles  unless  oxygen  is  used. 

Kent  says:  "At  the  sea  level  the  pressure  of  the  air  is  14.7  pounds  per  square 
inch;  at  %.  mile  above  the  sea  level  it  is  14.02  pounds;  at  ^  mile  it  is  13.33;  at  % 
mile  it  is  12.66;  at  i  mile  12.02;  at  i^4  miles  11.42;  at  i%  miles  10.88;  at  2  miles 
9.80  per  square  inch." 

'It  is  a  good  rule  to  remember  that  pressure  decreases  ^  pound 
per  square  inch  for  each  1000  feet  of  vertical  distance  within  the 
range  normally  traversed  by  the  aviator.  This  rule  enables  rough 
approximation  of  pressure  at  any  altitude  and  gives  data  sufficiently 
definite  for  practical  purposes. 

At  an  altitude  of  18,500  feet  a  cubic  foot  of  air  has  only  half  the 
weight  of  a  cubic  foot  of  air  at  sea  level. 

Hydroplanes  are  heavy  and  cannot  attain  the  same  heights  reached 
by  lighter  machines  built  for  aviation  on  land.  The  practical  limit 
of  hydrbplanes  today  appears  to  be  about  16,000  feet. 

The  aviator  should  be  selected  after  a  most  rigorous  physical  exami- 
nation in  which  especial  attention  is  paid  to  his  organs  of  equilibration. 
The  "air  feel"  cannot  be  developed  without  proper  function  of  the 
organs  of  equilibration.  The  aviator  must  be  keen,  alert,  act  ve, 

266 


AVIATION  267 

powerful,  and  in  full  possession  of  vigorous  strength  and  manhood, 
for  he  is  compelled  to  venture  into  physical  conditions  abnormal  to 
the  average  human  being.  Oxygen  poverty  of  the  air  in  high  levels 
max  interfere  seriously  with  his  performance  of  any  muscular  work, 
unless  an  oxygen  supply  is  carried. 

The  Manual  for  the  Medical  Department  of  the  U.  S.  Navy  prescribes  the  follow- 
ing -xamination  for  candidates  for  aviation  duty  (this  is  in  addition  to  the  examina- 
tion for  physical  fitness  for  general  service). 

(a)  Normal  vision  (at  least  20/20)  in  each  eye  will  be  required,  and  no  variation 
below  the  prescribed  minimum  standard  height  or  below  the  mean  chest  circumfer- 
ence and  the  prescribed  expansion  shall  be  allowed.  In  all  such  candidates  a  normal 
heart  and  normal  lungs  with  full  and  free  expansion  are  of  prime  importance.  Blood 
pressure  will  be  taken  before  and  after  exercise  and  any  marked  departure  from  nor- 
mal will  be  cause  for  rejection.  A  urinary  examination  will  also  be  made  and  disease 
so  disclosed  will  invariably  lead  to  rejection. 

(6)  In  requiring  normal  acuteness  of  vision  and  hearing,  medical  officers  are  cau- 
tioned to  recognize  that  such  acuteness  is  merely  one  factor  in  normal  functions  of 
eyes  and  ears,  separately  and  coordinately.  For  instance,  accident  in  landing  an 
airplane  may  be  regarded  as  frequently  due  to  error  of  judgment  in  regard  to  dis- 
I'rom  earth  at  the  time  the  machine  should  be  "flattened  out."  Yet,  correct 
judgment  depends  upon  many  factors  and  even  simple  acuity  of  vision  can  be  con- 
sidered as  being  of  great  importance  at  times  in  such  cases.  Furthermore,  while 
judgment  may  depend  essentially  upon  central  conditions,  it  also  has  important 
rela  :ion  to  reflexes  from  eyes  and  ears  which  may  dominate  those  conditions.  There- 
for, in  that  direction  can  frequently  be  found  varying  ability  of  central  nervous 
s  to  maintain  coordination  and  a  normal  sense  of  equilibrium  with  reference 
to  acts  urgently  required.  Hence,  full  functions  of  eyes  and  ears  are  essential  for 
duty  in  the  Flying  Corps,  but  acuity  of  vision  and  hearing  is  only  a  part  of  those 
functions.  Nevertheless,  good  vision  is  very  helpful  in  selecting  a  suitable  landing 
field  in  forced  landings  and  in  allowing  efficiency  without  glasses  or  goggles  that  can 
be  i u-hed  out  of  the  way  when  obscured  at  any  time  by  oil  (engine-in-front  type); 
while  normal  hearing  has  been  found  to  give  essential  assistance  in  detecting  the  first 
rnginr  iK  it  i  t  while  in  the  air  or  in  detecting  such  defect  prior  to  flight. 

(c)  In  considering  eyes,  all  practicable  attempts  will  be  carefully  made  to  seek 
indicat  ions  of  abnormality  of  function  in  any  direction.     In  that  connection  reference 
is  made  to  requirement  of  even  pupils  and  equal  and  full  reactions  to  light  and  dis- 

and  also  to  freedom  from  any  appearance  of  disease  in  eyes  and  adnexa. 
Strabi>mus  or  squint  in  any  manifest  degree  is  cause  for  rejection.     Ocular  move- 
ment-, observed  while  having  the  eye>  follow  the  linger  of  the  examiner,  must  show 
no  lack  of  coordination,  and  there  must  be  no  nystagmus  on  turning  the  eyes  to 
•  r  left  40  di  hen  looking  to  the  front. 

(d)  In  relation  to  ears,  the  hr>t  con-idcrat ion  i>  acuteness  of  hearing  which  will  be 
nined  by  tin    u-ual  methods;  but  in  the  uatih  test  the  examiner  shall  use  a 

wat<  h  he  ha>  standardi/ed.      For  that  purpose  he  -hall  -ati-fv  himself  as  to  the  usual 
•<•  maximum  distance  the  watch  is  heard  by  at  least  five  men  found  to  have 


268  NAVAL   HYGIENE 

normal  drums  and  considered  from  association  to  have  normal  hearing.  The  deter- 
mination must  be  made  under  the  conditions  to  which  candidates  would  be  sub- 
jected in  carrying  out  the  test,  and  the  distance  in  inches  so  determined  shall  be 
used  as  the  denominator  in  computing  the  usual  fraction  for  the  record;  but  the 
full  distance  will  be  required  for  acceptance.  The  drum  and  auditory  canal  of  each 
ear  will  then  be  examined  with  a  speculum.  Perforation,  pus,  odor,  or  any  evident 
condition  of  disease  is  cause  for  rejection.  Indication  of  middle-ear  trouble  shall  be 
regarded  as  of  special  importance,  and  it  should  be  recognized  that  such  indication 
is  often  found  in  the  very  diminution  of  the  sense  of  hearing  which  is  regarded  as  a 
cause  of  rejection.  A  contributory  cause  should  be  sought  in  examination  of  nasal 
septum  and  for  those  conditions  of  the  throat  and  nose  suggestive  of  interference 
with  patulousness  of  eustachian  tubes,  such  interference  not  only  being  in  associa- 
tion with  middle-ear  disturbances,  but  also  preventing  the  aviator  from  securing 
the  required  balance  of  air  pressure  on  the  ear  drums  when  ascending,  or,  of  special 
importance,  in  more  or  less  rapid  descents. 

(e)  The  practicability,  or  even  advisability,  at  this  time  of  seeking  to  make  defi- 
nite inquiry  into  functions  of  equilibrium  through  nystagmus  induced  by  excitation  of 
vestibular  mechanism  may  be  regarded  as  more  or  less  in  question  in  view  of  normal 
differences  and  also  of  variations  in  the  personal  equations  of  examiners.  Such 
nystagmus  may  be  produced  by  rotary,  caloric,  compression,  or  galvanic  methods. 

(/)  However,  in  seeking  abnormality  in  function  of  equilibrium  there  are  certain 
valuable  static  and  dynamic  tests  that  must  be  made  at  each  examination.  In 
these  tests  the  candidate  is  required,  without  shoes,  and  first  with  eyes  open  and  then 
closed,  to: 

1.  Stand  with  knees  well  back  and  inner  margin  of  feet  touching; 

2.  Stand  on  toes  in  position  i; 

3.  Stand  flat  on  right  foot  and  rest  left  foot  on  right  knee  or  instep; 

4.  Stand  flat  on  left  foot  and  rest  right  foot  on  left  knee  or  instep; 

5.  Walk  forward  with  feet  flat; 

6.  Walk  to  the  right  in  a  circle  with  feet  flat; 

7.  Walk  to  the  left  in  a  circle  with  feet  flat; 

8.  Walk  backward  with  feet  flat; 

9.  Hop  backward  on  both  feet  flat; 

10.  Hop  backward  on  right  foot  flat; 

11.  Hop  backward  on  left  foot  flat. 

Position  i  should  be  held  for  two  minutes  without  abnormal  swaying,  and 
position  2  for  a  minute.  Normal  attempts  at  balancing  have  no  significance.  Posi- 
tions 3  and  4  should  be  held  for  at  least  a  quarter  of  a  minute.  In  tests  6  and 
7  there  should  not  be  expectation  of  candidate  making  mathematical  circle,  espe- 
cially with  eyes  closed,  but  only  that  he  will  normally  tend  to  follow  the  general 
direction  of  a  circle.  In  making  these  tests  and  watching  for  abnormal  deviations, 
the  examiner  must  recognize  that  they  have  relation  not  only  to  peripheral  nerve 
disturbances  but  also  to  central  conditions,  especially  those  of  luetic  origin,  and 
that  the  patella,  tendo  Achillis,  and  pupillary  reflexes  must  be  considered  with 
them.  In  the  case  of  the  candidate  examined  for  transfer  or  detail  the  blood-serum 
test  for  specific  disease  will  also  be  secured,  and  such  test  will  be  secured  in  other 
cases  when  practicable. 


AVIATION  269 

(g)  The  static  and  dynamic  tests  must  also  be  considered  in  connection  with  the 
ilied  routine  examination  to  determine  the  free  and  full  movements  of  joints. 
In  relation  (<>  the  knee  and  ankle  joints  it  is  evident  that  their  finer  movements  play 
a  vtry  important  part  in  rudder  control,  especially  in  a  fast  machine  requiring 
(jui(  < -at  tinu;  controls.  Difficulty  in  those  joints  may  also  lead  to  the  abnormal  posi- 
tion in  an  airplane  that  tends  to  cramping  of  muscles. 

(h)  In  the  consideration  of  a  suitable  type  of  individual  the  anemic  should  be 
discarded,  and  also  the  asthmatic,  emphysematous,  or  obese.  The  desire  is  for  the 
active  with  freedom  from  disease  and  objectionable  tendencies.  In  that  relation 
the  history  of  the  individual  may  be  of  great  importance  and  consequently  must  be 
sought.  Is  there  story  of  eye  trouble,  such,  for  instance,  as  double  vision?  Is 
there  history  of  ear  trouble,  such  as  earache,  discharge,  noises,  or  mastoiditis? 
What  is  the  history  as  to  enuresis,  asthma,  rheumatism,  seasickness,  swing  sickness, 
vertigo,  headache,  and  head  injury?  These  questions  relate  to  both  disease  and 
type  and  can  readily  furnish  information  upon  which  rejection  should  be  based. 
A  candidate  whose  history  or  condition  shows  lues,  or  any  of  the  chronic  intestinal 
disorders  tending  to  dizziness,  should  be  rejected,  as  well  as  he  who  is  found  to  have 
inclination  toward  a  habit  that  disturbs  mental  balance,  such  as  toward  alcohol  or 
other  drug. 

(i)  In  either  adult  or  minor  a  chest  expansion  of  less  than  2^  inches  is  a  sufficient 
cause  for  the  rejection  of  the  applicant,  and  there  shall  be  no  variation  below  the 
presi  ribed  chest  measurements.  In  the  case  of  minors  no  under  weight  or  under 
height  is  allowed,  and  in  regard  to  adults  the  weights  given  for  64,  65,  and  66  inches 
will  be  regarded  in  each  case  as  a  minimum.  No  adult  above  66  inches  will  be 
accepted  with  less  weight  than  132  pounds,  and  in  such  a  case  no  variation  greater 
than  7  pounds  below  the  prescribed  weight  for  height  will  be  allowed.  But  in  all 
cases  the  applicant  must  be  active,  with  firm  muscles,  and  evidently  vigorous  and 
healthy.  Consequently,  marked  disproportion  of  weight  over  height  will  also  be  a 
tor  rejection  when  it  is  an  indication  of  obesity.  Special  attention  will  be 
Kivrr  to  obesity  and  to  any  tendency  in  that  direction  disclosed  by  family  history 
or  MI  Bested  by  disproportion  of  weight  over  height.  Examiners  will  regard  obesity 
or  tendency  to  obesity  as  cause  for  rejection  in  all  cases. 

In  addition  to  the  usual  physical  examination  to  which  candidates 
for  ihe  aviation  corps  now  are  subjected,  I  am  of  opinion  that  these 
can*  idates  should  be  subjected  to  decompression  tests  in  which  their 
tok  tance  of  oxygen  partial  pressure  and  the  effects  of  greatly  decreased 
air  pressure  may  be  demonstrated  before  such  a  demonstration  is  made 
in  practice  with  possible  fatal  result  from  losing  control  of  the  machine. 

The  aviator's  vital  organs  must  be  trained  to  accommodate  them- 
M-lvi-s  to  changes  of  temperature  and  pressure  incident  upon  ascents 
to  h  uli  altitudes  and  descents  from  them,  which  ascents  and  descents 
arc  made  with  sufficient  speed  to  tax  greatly  the  accommodative  power 
of  the  human  organism.  Rate  of  ascent  should  not  be  too  rapid  to 


270 


NAVAL   HYGIENE 


prevent  adjustment  of  the  body  to  diminished  oxygen  partial  pressure, 
and  descents  should  be  slow  enough  to  enable  readjustment  of  the 
heart  to  atmospheric  pressure  at  sea  level. 

The  body  possesses  remarkable  adaptability  to  varying  air  pres- 
sures. An  English  aviator  is  said  to  have  risen  to  an  altitude  of  20,000 
feet  and  returned  to  earth  in  twenty-one  and  four-fifth  minutes.  Such 
performances  impose  great  strain  upon  the  cardiovascular  system. 
Physical  discomfort  upon  the  attainment  of  great  altitudes  seems  less 
than  might  be  expected.  It  is  possible  that  diversion  is  a  potent  factor 
in  reducing  the  appreciation  of  conditions  which  in  other  circumstances 
would  make  deeper  impress  upon  the  nervous  system. 

Air  sickness,  a  condition  analogous  to  seasickness,  is  not  uncommon 
in  those  beginning  to  fly,  especially  if  they  meet  "rough  air." 

The  aviator's  attention  must  be  so  fixed  upon  the  operation  of  his 
machine  that  he  has  little  time  to  think  of  his  personal  discomforts. 
He  must  steer  in  three  planes,  must  go  at  high  speed  in  order  to  prevent 
falling,  and  must  keep  his  attention  concentrated  upon  his  complicated 
motor. 

The  duties  are  of  such  character  as  to  make  heavy  demands  upon 
the  nervous  system.  Constant  high  tension,  fear,  anxiety  in  listening 
for  defects  in  machinery,  tax  the  nervous  system  especially.  Von 
Schroetter  says  aviators  suffer  more  nervous  strain  than  balloonists 
who  do  not  have  to  concentrate  upon  manipulation  of  the  machine. 

Captain  H.  L.  Schurmeier,  M.  R.  C.,  U.  S.  Army,  made  extended 
observations  on  a  group  of  20  men  daily  before  and  after  •  flight 
over  a  period  of  six  weeks  and  found  the  blood-pressure  higher  before 
ascent  than  after  descent,  unless  the  subject  had  had  some  disagreeable 
experience  in  the  air. 

Variations  in  diastolic  and  systolic  pressures  were  in  the  same  pro- 
portion. The  differences  of  blood-pressure  were  more  marked  in  those 
who  were  learning  to  fly  than  in  experienced  aviators.  The  differences 
in  blood-pressure  noted  by  Captain  Schurmeier  are  at  variance  with 
those  of  some  other  observers  who  state  that  the  blood-pressure  is 
increased  upon  descent  after  flight.  It  is  probable  that  this  difference 
is  more  apparent  than  real,  and  that  Captain  Schurmeier's  observations 
were  made  upon  inexperienced  fliers  while  the  other  observations  alluded 
to  were  made  upon  experienced  aviators. 

Major  Ralph  N.  Greene,  Medical  Corps,  Florida  National  Guard, 
while  he  was  serving  as  medical  officer  at  the  aviation  post,  Fort  Sam 


AVIATION  271 

Houston,  Texas,  made  a  number  of  flights  with  aviators  and  took 
blood-pressure  readings  upon  himself  and  his  pilot  at  different  alti- 
ti  des.  Tin-  Tycos  instrument  was  used.  He  found  that  the  normal 
readings  on  the  ground  were  "no  to  120."  At  an  altitude  of  6000 
feet  the  readings  were  200,  and  this  reading  was  not  exceeded  in  rising 
to  an  altitude  of  11,000  feet.  It  is  assumed  that  the  reading  refers  to 
tic-  systolic  blood-pressure.  The  observer  does  not  state  what  the  di- 
abolic pressure  was.  He  complained  of  "mild  acceleration  in  heart 
action"  and  "an  ever-increasing  sense  of  roaring  and  tension  in  the 
head."  He  does  not  give  any  blood-pressure  readings  made  after 
descent. 

Huber  ("Reference  Hand  Book  of  Medical  Sciences")  states  that 
rapid  descent  at  a  rate  four  times  faster  than  ascent  causes  vaso- 
motor  disturbances,  rise  of  blood-pressure,  and  quickening  of  heart 
rate. 

Chavez,  after  flying  over  the  Alps  at  an  elevation  of  19,000  feet,  fell  fracturing 
bcth  legs.  He  died  later  in  delirium,  and  his  death  was  attributed  to  vasomotor 
and  myocardial  disorder,  resulting  from  his  flight — not  the  fractures. 

The  duty  of  instruction  is  trying  because  of  long  hours  spent  in  the 
air. 

Flights  of  great  altitude  involve: 

1.  Decreased  partial  pressure  of  oxygen; 

2.  Lowered  arterial  blood-pressure; 

3,-  Reduction  in  temperature  of  the  air. 

Permanent  residence  at  high  altitudes  shows  increase  of  red  cells 
frmi  seven  to  eight  million  per  cubic  millimeter.  Since  the  body's 
demand  for  oxygen  is  constant,  this  increase  in  red  blood  cells  appears 
lo  be  Nature's  effort  to  compensate  for  deficient  oxygen  partial  pressure. 

At  an  altitude  of  12,000  feet  vertigo  and  headache  are  experienced 
and  the  discomfort  increases  in  proportion  to  ascent  above  this  level. 
Nausea,  sleepiness,  and  possible  unconsciousness  supervene.  The 
low  temperature  causes  chilling  of  the  skin  and  compensatory  increase 
of  kidney  funrlion.  At  18,000  feet  even  with  the  use  of  oxygen  the 
di>eomfort  is  felt,  especially  the  low  temperature.  At  high  altitudes 
the  monotony  of  the  whirr  of  the  machinery,  the  hypnotic  effect  of 
the  propeller,  and  the  remoteness  of  fixed  objects  to  engage  attention 
tend  to  produce  subconsciousness  or  hypnotic  state. 

Lapses  of  consciousness  occasionally  affect  aviators  and  undoubt- 
edly cause  some  of  the  accidents  which  are  experienced  by  air  men. 


272  NAVAL  HYGIENE 

These  lapses  of  consciousness  may  occur  while  the  aviator  is  in  the  air 
or  after  descent. 

An  aviator  has  told  the  writer  of  an  experience  in  which  conscious- 
ness was  lost  at  17,000  feet  and  not  regained  until  the  i2,ooo-foot 
level  had  been  reached.  He  was  bleeding  from  nose  and  ears  at  this 
time. 

The  cause  of  this  condition  is  obscure.  Probably  it  is  due  to  vaso- 
motor  disturbance  resulting  from  sudden  transition  from  a  lower  to  a 
higher  air  pressure  or  vice  versd.  It  may  be  an  exaggeration  of  the 
sense  of  giddiness  often  experienced  upon  rising  suddenly  from  a 
recumbent  posture  while  the  heart  is  accommodating  itself  to  the  addi- 
tional work  suddenly  thrust  upon  it.  Hypnosis  induced  as  result  of 
monotonous  noise  of  the  motor,  and  absence  of  points  of  fixation  for 
the  eyes  may  be  a  possible  cause. 

The  effect  of  inhalation  of  gasolene  should  be  mentioned  in  this 
connection.  Likewise  inhalation  of  exhaust  gases  might  produce  un- 
consciousness by  poisoning  short  of  fatality. 

So  competent  an  aviator  as  Latham  suffered  this  effect  upon  his 
nervous  system  when,  in  making  an  exhibition  flight,  he  started  to 
descend,  and  according  to  his  statement  was  conscious  of  nothing  after 
he  had  descended  to  a  certain  level  until  he  landed  with  his  machine  on 
top  of  the  grand  stand,  a  happening  calculated  to  rouse  one  to  a  con- 
scious state  from  almost  any  condition. 

Apparent  unconsciousness  is  seen  occasionally  after  descent.  Its 
cause  is  not  clear. 

Speed  necessary  for  the  airplane  to  keep  the  air  produces  con- 
junctival  congestion,  and  bright  light  causes  photophobia  and  general 
ocular  discomfort.  This  condition  is  known  as  "aviator's  dazzling." 

Crews  of  anti-aircraft  guns  are  especially  liable  to  irritation  of 
conjunctiva  and  retina  as  result  of  careful  watch  of  bright  sky  for  the 
appearance  of  hostile  aircraft. 

Of  all  tinted  glasses  recommended  to  prevent  "aviator's  dazzling" 
"euphos"  glasses  probably  are  best,  and  should  be  worn  as  goggles. 
Eye  glasses  of  any  kind  are  apt  to  become  fogged  by  moisture  from  the 
breath,  or  by  oil  when  the  so-called  "tractor"  type  of  machine  is 
used.  "Euphos,"  smoked  or  tinted  glasses  are  a  very  necessary  pro- 
tection for  the  eyes  during  flight.  There  is  much  glare,  especially  in 
flying  above  the  clouds,  from  which  the  sunlight  is  reflected  in  a  very 
dazzling  degree. 


AVIATION  273 

When  flying  over  water  there  are  certain  conditions  of  the  atmos- 
phere which  cause  great  confusion  and  accident  at  times.  When  the 
water  is  smooth  the  aviator  has  difficulty  in  determining  its  level  upon 
attempting  to  descend  to  the  surface. 

One  aviator  who  had  no  barograph  in  his  machine  thought  he  was 
about  5  feet  above  the  surface  of  the  water  and  leveled  up  his  machine 
to  land  when  his  eye  detected  a  buoy  a  long  distance  away  and  below 
him.  By  means  of  this  buoy  he  realized  that  in  reality  he  was  about 
i ocx)  feet  above  the  water.  The  horizon  proves  of  value  to  the  aviator 
in  attempting  to  "land"  on  water,  but  there  are  certain  conditions  of 
the  atmosphere  which  produce  a  mirage  effect  or  which  prevent  iden- 
tification of  the  horizon  line.  In  such  circumstances  landing  is  diffi- 
cult and  dangerous  unless  buoys  or  other  landmarks  are  present  to 
indicate  the  line  of  demarcation  between  air  and  water. 

The  aviator  ashore  must  be  on  careful  lookout  for  overhead  wires 
in  ascending  and  descending,  and  in  flight  over  the  earth  he  constantly 
must  examine  the  terrain  subconsciously  bearing  in  mind  that  accident 
may  necessitate  descent  at  any  moment  and  clear  space  for  landing 
may  be  needed. 

The  noise  of  the  motor  tends  to  produce  temporary  deafness  in 
those  who  do  not  use  cotton  in  the  ears,  and  likewise  the  varying  atmos- 
pheric pressures  produce  their  effects  upon  the  tympanic  membrane. 
Unquestionably  continued  exposure  will  result  in  certain  degrees  of 
deafness. 

Swallowing  tends  to  equalize  the  air  pressure  on  the  inner  side  of 
the  tympanic  membrane  with  that  on  the  outer,  and  should  be  kept  up 
whenever  uncomfortable  pressure  is  felt  in  the  ears. 

Rainstorms  produce  much  discomfort  to  the  aviator  (as  also  would 
hail  or  sleet).  When  the  drops  strike  his  face  as  the  machine  goes  at  a 
hifch  rate  of  speed  they  are  said  to  "cut  like  a  knife"  in  addition  to 
wetting  and  chilling. 

Extreme  cold  causes  its  usual  effects  and  considerable  suffering 
to  fliers.  Subnormal  mouth  temperature  has  repeatedly  been  ob- 
M/rved.  The  following  means  to  alleviate  this  suffering  have  been 
employed: 

i.  The  exhaust  from  the  engine  has  been  led  into  the  space  occupied 
by  the  aviator  (fusilage),  and,  although  these  gases  are  poisonous  if 
breathed  in  concentration,  the  heat  imparted  by  them  contributes  to 
comfort. 

18 


274 


NAVAL  HYGIENE 


2.  Electrically  heated  garments  are  used  in  battle-planes. 

3.  The  so-called  Japanese  stove  may  be  used  in  pockets  and  within 
the  clothing. 

4.  Special  air-proof  and  water-proof  clothing. 

An  emergency  .ration  is  provided,  likewise  a  water  supply. 

At  great  altitudes,  that  is  above  20,000  feet,  oxygen  apparatus  may 
have  to  be  used  to  generate  oxygen  for  purposes  of  respiration.  An 
apparatus  similar  to  the  so-called  smoke  helmet  has  been  used  with 
satisfaction.  Oxygen  is  used  by  the  fliers  at  the  western  front  daily  in 
making  reconnaissances. 


FIG.   1 02. — Launching  a  hydroplane  from  a  ship. 

It  must  be  remembered  that  when  oxygen  partial  pressure  is  re- 
duced until  life  is  supported  with  difficulty,  combustion  likewise  is 
difficult  and  oxygen  or  compressed  air  must  be  carried  for  the  motors 
as  well.  A  fuel  impregnated  with  oxygen  may  be  developed. 

Aviators  are  strapped  in  the  machine  in  order  that  a  minimum  of 
injury  may.  be  experienced  in  case  of  accident  to  the  plane. 

If  flying  at  high  altitudes  the  aviator  should  be  able  to  disengage 
himself  from  his  machine  in  case  of  its  falling  and  trust  to  the  parachute 
which  should  be  attached  to  him  before  his  ascent. 

Aviators  belonging  to  the  naval  establishment  spend  considerable 
time  on  shore  and  are  subject  to  endemic  diseases  of  the  locality  in 
which  they  may  be  serving.  For  instance,  malaria,  dengue. 


AVIATION 


275 


Ships  from  which  aviators  operate  are  confronted  with  the  problem 
of  launching  the  aviator.  The  catapult  is  an  apparatus  which  has  been 
devised  lOr  (his  purpose.  It  consists  of  a  track  on  the  deck  of  the  ship 
which  runs  upward  on  an  inclined  plane  in  order  that  the  aeroplane 
may  gain  as  much  elevation  as  possible  when  it  clears  the  ship. 

The  aeroplane  is  placed  upon  a  car  on  the  track,  and  when  all  is 
ready,  the  aviator  being  seated,  the  propeller  running  at  high  speed, 
by  means  of  compressed  air  and  a  cable,  the  car  carrying  the  aeroplane 
is  dragged  rapidly  along  the  track  to  its  end,  where  the  car,  going  at  the 
rate  of  45  miles  an  hour,  hurls  the  aeroplane  clear  of  the  ship  at  a 
speed  and  elevation  which  enable  the  plane  to  continue  its  ascent  with- 
out striking  the  water. 

Surgeon  Cottle,  U.  S.  Navy,  states  concerning  the  catapult  that 
"accidents  to  the  machine  are  not  infrequent,  but  they  seldom  injure 
the  aviator  beyond  a  wetting.  Accidents  serious  enough  to  injure  the 
aviator  have  resulted  in  death  from  the  impact  of  the  fall  alone  or 
from  the  combination  of  the  stunning  effect  of  the  fall  with  drowning." 

When  the  plane  is  about  to  be  launched  a  motor  launch  containing 
a  medical  officer  should  be  in  the  water  ready  for  rescue  in  case  of 
accident. 

While  the  possibility  of  launching  the  aviator  and  his  machine  from 
the  deck  of  a  moving  ship  is  admitted  the  practicability  of  the  procedure 
when  the  ship  is  rolling  considerably  is  problematical. 

Granting  the  possibility  of  successful  launching  from  a  ship  in  a 
seaway  the  return  of  the  aviator  appears  impossible  in  heavy  weather. 
The  machine  would  he  seriously  damaged  if  not  lost  in  an  attempt  to 
land  on  a  rough  sea. 

The  captive  balloon  would  seem  to  be  safer  than  the  aeroplane  for 
cooperation  with  naval  forces  in  any  weather  except  a  smooth  sea. 


CHAPTER  XVIII 
SUBMARINES 

General  Type. — Submarine  vessels  correspond  in  general  shape  to 
the  ordinary  ship,  but  are  strongly  constructed  in  order  that  they 
may  withstand  the  pressure  resulting  from  submergence  to  about 
300  feet.  They  vary  in  size  from  500  to  1000  tons,  and  carry  a  crew 
of  about  25  men.  Submarine  vessels  at  present  are  used  exclusively 
as  war  vessels.  When  running  on  the  surface  they  are  propelled  by 
oil  engines,  and  when  submerged,  by  electric  storage  batteries. 

When  the  vessel  is  running  on  the  surface  in  a  smooth  sea  the  hatch 
leading  into  the  conning  tower  and  also  other  hatches  on  the  upper 
deck  of  the  craft  may  be  left  open,  thus  facilitating  natural  as  well 
as  artificial  ventilation.  In  a  moderately  rough  sea,  when  all  openings 
must  be  closed  except  the  small  ventilating  tube,  accompanying  the 
periscope,  which  tube  supplies  air  to  the  forward  part  of  the  ship,  the 
conditions  become  very  uncomfortable.  When  the  ship  submerges 
all  communication  with  the  outer  air  is  closed. 

When  submarines  are  at  the  dock  or  at  anchor  and  are  charging 
the  storage  batteries  the  fumes  from  the  exhaust  often  are  blown  in 
such  way  that  those  on  the  bridge  or  deck  must  breathe  them.  The 
fumes  gain  access  through  the  open  hatches  or  a  ventilating  intake 
into  the  boat  itself. 

When  running  submerged  this  condition  is  not  so  marked  since 
the  boat  is  then  propelled  by  an  electric  storage  battery.  Less  dis- 
comfort is  experienced  by  the  crew  during  a  submergence  run  of  several 
hours  than  during  a  run  of  similar  duration  on  the  surface.  The 
storage  batteries  do  not  vitiate  the  air  to  the  same  extent  as  the  oil 
engines. 

After  a  series  of  observations  made  on  board  a  submarine,  Surgeon 
E.  W.  Brown,  U.  S.  Navy,  and  Naval  Constructor  McEntee,  U.  S. 
Navy,  recommend  that  the  concentration  of  oxygen  should  not  be 
permitted  to  fall  below  15  per  cent,  and  that  the  percentage  by  volume 
of  carbon  dioxide  be  not  allowed  to  exceed  2  per  cent. 

276 


SUBMARINES  277 

These  observers  found  that  the  consumption  of  oxygen  averages 
0.9  cubic  foot  per  man  per  hour. 

The  crew  of  a  submarine  lives  in  a  per  capita  air  space  far  below 
that  regarded  as  a  minimum  aboard  ships. 

The  initial  volume  of  air  soon  is  vitiated  beyond  acceptable  standard 
by: 

1.  Human  beings;  and 

2.  Materiel. 

1.  Human  beings  add  to  the  air: 

(a)  Carbon  dioxide; 

(b)  Humidity; 

(c)  Emanations  from  skin,  clothing,  excreta,  alimentary  canal, 

(feces,  flatus  and  vomitus  from  seasickness),  and  food  or 
its  preparation; 

they  withdraw  oxygen  from  the  air. 

2.  Materiel  adds  to  the  air: 

(a)  Heat  from  illumination  and  from  machinery  in  motion; 

(b)  Gases  from  fuel  oil  or  from  its  combustion  (whether  com- 

»plete  or  incomplete) ; 
(c)  Gases  from  storage  batteries; 

(d)  Emanations  from  lubricant  materials. 

Surgeon  Kress  of  the  U.  S.  Navy  has  shown  that  the  number  of  microorganisms 

the  air  on  submarines  during  submergence  is  greatly  reduced,  indeed  there  are 
:wer  organisms  present  per  cubic  meter  than  when  the  ventilation  is  at  its  best. 
[e  attributed  this  to  the  high  humidity  and  absence  of  dust  particles,  comparing 
ie  condition  of  the  air  with  that  of  the  interior  of  large  sewers,  where  the  atmosphere 
remarkably  free  of  bacterial  content  because  of  the  absence  of  dust. 

He  found  an  average  of  2800  organisms  per  cubic  meter  in  the  several  compart- 
lents  of  a  ship  studied  by  him  as  she  lay  at  the  dock,  and  later  at  sea  found  an  aver- 
;e  of  500  organisms  per  cubic  meter  in  the  same  spaces.  He  attributed  this  to  the 
'aspirating  action  of  engines  and  suction  of  ventilators  leading  from  battery  com- 
irtments  into  the  batteries."  Undoubtedly  this  is  in  part  correct,  but  since  the 
lip  had  been  cruising  on  the  surface  the  air  taken  in  probably  was  almost  sterile 

it  entered  the  ship. 

The  distance  of  the  ship  from  the  shore  was  not  stated,  but  since  she  was  on  a 
lirty-six  hour  endurance  run  it  is  possible  that  she  was  approximately  100  miles 
om  shore,  at  which  distance  sea  air  is  practically  sterile. 

Ventilation.  Tin-  ventilation  of  submarines  is  a  problem  which 
as  occupied  the  brightest  minds  of  naval  constructors  and  sanitary 
igineers  for  some  time  past.  The  crew  of  the  submarine  performs 


278  NAVAL  HYGIENE 

its  duties  under  conditions  which  may  be  compared  to  those  at  the 
bottom  of  a  large  bottle.  The  facilities  for  air  interchange  are  totally 
inadequate  for  the  needs  of  the  crew  at  rest,  far  less  so  when  they  are 
at  work.  Further  to  complicate  the  problem  of  ventilation  the  sub- 
marine is  divided  into  several  water-tight  compartments,  some  of 
which  contain  machinery,  storage  batteries,  living  spaces,  torpedo 
tubes,  air  tanks,  etc.  For  some  time  the  difficult  disposal  of  excreta 
added  its  discomforts  to  the  conditions  under  which  the  crew  had  to 
live.  The  relative  humidity  is  usually  high,  and  during  submergence 
the  heat  generated  by  machinery  causes  additional  evaporation  and 
more  nearly  approximates  saturation  for  temperature. 

The  ventilation  of  the  submarine  running  on  the  surface  is  difficult 
enough,  but  the  problem  is  greatly  increased  during  submergence.  In 
temperate  climates  the  temperature  during  submergence  is  low,  and 
indeed  during  the  winter  submarine  cruising  is  full  of  discomfort  be- 
cause of  the  low  temperature  and  great  humidity  within  the  vessel. 

The  oxygen  in  the  available  air  supply  of  the  submarine  may  be 
reduced  to  about  16  per  cent,  before  distress  is  felt.  The  problem  is 
to  remove  the  carbon  dioxide  and  vitiating  gases  rather  than  to  supply 
oxygen. 

Various  processes  (chemical  and  mechanical)  have  been  devised  for 
removal  of  vitiated  air  in  submarines,  as  well  as  for  the  removal  of 
humid  heated  air.  For  military  reasons  secrecy  concerning  these 
devices  is  observed  by  the  several  nations.  It  appears  probable,  how- 
ever, that  a  system  of  rebreathing  after  passing  the  vitiated  air  through 
chemical  processes  and  adding  oxygen  may  be  employed  satisfactorily. 
This  would  be  the  application  of  the  principle  of  the  smoke  helmet  on 
a  large  scale. 

The  principal  pollutions  of  the  air  due  to  materiel  in  submarine 
boats  are: 

(a)  Hydrogen  evolved  from  the  battery  plates  during  charging  of 
storage  batteries,  and  even  when  charging  actually  is  not  going  on  a 
small  amount  of  hydrogen  is  given  off.     If  the  concentration  of  this 
gas  in  the  air  becomes  so  great  as  8  to  10  per  cent,  an  explosive  mixture 
is  formed  which  may  be  set  off  by  the  sparking  of  an  electric  motor, 
lighting  of  a  match,  etc.,  and  disastrous  consequences  may  follow. 
Hydrogen  detectors  are  now  in  use. 

(b)  Sulphuric    acid    fumes    occasionally    are    evolved    from    the 
accumulators. 


SUBMARINES  279 

(c)  Chlorine  may  be  rapidly  generated  as  the  result  of  sea  water 
coming  into  an  electric  circuit.     The  water  is  electrolyzed  between  the 
poles  of  the  circuit,  and  the  compartment  may  be  quickly  rilled  with 
sufficient  chlorine  to  make  the  air  irrespirable.     This  may  occur  either 
a-  result  of  accident  to  wires  or  constant  entrance  of  salt  water  into 
the  accumulator  cells. 

(d)  Carbon  monoxide  may  be  generated  as  the  result  of  incomplete 
combustion  of  the  gasolene  used  for  propulsion  when  the  boat  is  run- 
ning awash.     This  difficulty,  however,  has  been  almost  overcome  and 
only  by  accident  is  the  air  apt  to  be  polluted  in  this  way. 

(e)  The  fumes  from  the  fuel  oil  tanks  may  attain  considerable  con- 
centration in  certain  compartments  and  become  very  objectionable. 
\Yhen  gasolene  fumes  attain  a  concentration  of  2  per  cent,  of  the  atmos- 
pheric air  an  explosive  mixture  is  formed.     The  odors  from  oils,  paints, 
preparation  of  food,  garbage  and  water  closets  all  contribute  to  the 
further  pollution  of  the  air  in  the  vessel. 

Variations  in  temperature  are  great.  The  boats,  although  heated 
by  electricity,  are  almost  always  quite  cold  in  temperate  latitudes, 
especially  the  outer  plates  whose  temperature  is  influenced  by  the 
water  in  which  the  ship  lies.  As  the  result  of  the  chilling  of  these 
plates  there  is  much  condensation  of  aqueous  vapor  from  the  atmos- 
phere within  the  submarine.  Sleeping  and  work  billets  should  be  as 
far  from  the  plates  as  practicable  in  order  to  prevent  chilling,  colds, 
and  respiratory  diseases.  Insulation  of  the  outboard  plates  with  wood 
or  cork  is  desirable  in  order  to  limit  the  chilling  of  work  stations  and 
sleeping  spaces. 

In  the  tropics  the  temperature  and  humidity  may  become  very  high. 
At  such  times  the  conditions  become  almost  unbearable. 

The  compressed  air  contained  in  the  huge  flasks  or  tanks  is  a 
hygienic  advantage.  It  is  used  primarily  for  the  purpose  of  producing 
additional  buoyancy  when  the  ship  is  submerged,  thus  bringing  her  to 
the  surface,  but  the  compressed  air  also  is  available  as  an  emergency 
air  supply,  and  the  duration  of  submergence  may  be  prolonged 
several  times  by  turning  on  the  compressed  air  supply  for  respiratory 
purposes. 

Air  in  the  compressed  air  tanks  is  under  high  pressure  and  when 
allowed  to  escape  into  the  trimming  tanks  it  forces  out  the  water,  thus 
increasing  the  buoyancy  of  the  boat  and  enabling  it  to  rise. 

An  electrically  driven  turbine  pump  also  may  be  used  to  expel 


280  NAVAL   HYGIENE 

water  from  these  tanks  when  it  is  desired  to  bring  a  submerged  boat 
to  the  surface. 

Artificial  ventilation  is  employed  in  several  different  ways  on  board 
submarines.  First,  by  aid  of  blowers  the  circulation  of  air  is  main- 
tained throughout  the  ship.  This  circulation  merely  agitates  and  dif- 
fuses the  air  and  causes  additional  comfort  by  facilitating  evaporation 
from  the  skins  of  the  crew.  Such  a  system  may  be  used  to  take  in 
fresh  air  from  without  through  ventilating  tubes  and  hatches  when  the 
vessel  is  on  the  surface  or  partially  submerged.  But  when  submer- 
gence is  completed  the  gate  valves  in  the  ventilating  tubes  must  be 
closed  to  prevent  entrance  of  water,  and  the  function  of  the  mechanical 
system  (blowers)  is  merely  that  of  maintenance  of  circulation  of  the 
contained  air,  regardless  of  its  purity  or  impurity. 

This  initial  volume  of  air  soon  will  become  vitiated  during  prolonged 
submergence,  and  in  such  circumstances  the  air  must  be  altered,  either 
by  the  admission  of  fresh  air  from  the  compressed  air  tanks,  or  by  the 
removal  of  carbon  dioxide  and  water  vapor  from  the  air  and  the  addi- 
tion to  the  air  of  oxygen  from  tanks  in  which  compressed  oxygen  is 
carried.  'The  carbon  dioxide  and  water  vapor  are  removed  by  forcing 
the  air  through  appropriately  contained  granules  of  the  following 
composition: 

Potassium  hydrate 19 .3    per  cent. 

Sodium  hydrate 66.21  per  cent. 

Sulphuric  acid i  .30  per  cent. 

Hydrochloric  acid . . , 0.66  per  cent. 

Water 12.52  per  cent. 

The  above  analysis  gives  the  composition  of  granules  in  use  in  the 
Italian  Navy  (from  translation  by  Medical  Inspector  J.  S.  Taylor,  U.  S. 
Navy,  of  description  by  Dr.  R.  Marantonio,  Major  Medical  Corps, 
Royal  Italian  Navy). 

In  certain  parts  of  the  ship,  for  instance  storage  batteries  and  com- 
bustion motors,  the  vitiated  air  may  be  drawn  into  foul  air  tanks, 
compressed,  and  expelled  from  the  boat  into  the  water  in  which  she  is 
submerged. 

Loss  of  Weight. — The  complaint  is  commonly  heard  that  men 
in  submarines  lose  weight  rapidly.  Observations  do  not  connrm 
this.  Seasickness,  lack  of  exercise,  limited  sphere  of  activity,  inhala- 
tion of  gas  fumes,  and  in  tropical  latitudes  the  temperature,  all  serve 


to  diminish  the  appetite  and  general  sense  of  well  being,  and  tend  to 
result  in  temporary  loss  of  weight  due  to  disturbance  of  metabolism. 

No  doubt  the  small  uncomfortable  toilets  are  a  factor  in  producing 
the  constipation  common  among  submarine  crews.  Water  closets 
of  the  pump  variety  are  used  below  the  surface.  When  running  on 
the  surface  a  temporary  "head"  or  water  closet  is  installed  on  deck. 

Members  of  the  crew  should  be  instructed  to  come  for  a  laxative 
if  the  bowel  is  not  emptied  regularly  each  day. 

The  stressful  conditions  of  submarine  duty  tend  to  develop  mental 
symptoms  in  individuals  who  would  not  exhibit  them  in  normal 
circumstances. 

The  Effect  on  Hearing.— The  great  humidity  together  with 
the  drafts  caused  by  artificial  ventilating  apparatus  upon  men  who  are 
overheated  tends  to  produce  colds  and  disorders  of  the  nose  and  throat. 
More  important,  however,  is  the  effect  of  service  on  submarine  boats 
upon  hearing. 

As  result  of  diving  the  increased  pressure  caused  by  the  escape  of 
air  from  the  air  flasks  within  the  boat  (this  amounts  to  about  J^ 
pound)  the  sense  of  hearing  becomes  gradually  duller,  and  finally  a 
considerable  degree  of  deafness  results. 

The  inhalation  of  gases  and  fumes  from  oil  tanks  and  batteries, 
constant  vibration  due  to  the  machinery,  as  well  as  cold  drafts,  appear 
to  be  the  probable  causes  of  this  deafness,  either  by  provoking  catarrh al 
conditions  which  extend  to  the  middle  ear  and  produce  permanent 
injury,  or  by  the  mechanical  effect  upon  the  auditory  nerve  produced 
by  the  constant  vibration. 

Effect  on  the  Nervous  System. — The  noise  and  vibration  of  ma- 
chinery in  the  confined  spaces  produce  serious  effect  upon  the  nervous 
m,  and  together  with  the  bad  air  cause  headaches,  auditory  dis- 
turbances, "gasolene  palpitation,"  irritability,  insomnia,  and  not  un- 
commonly men  are  overcome  by  gasolene  fumes.  The  constitutional 
effect  of  gasolene  fumes  resembles  the  stage  of  excitement  in  alcoholic 
intoxication,  and  has  been  aptly  called  the  "gasolene  jag."  Surgeon 
Mi  Dowcll,  I'.  S.  N.,  states  that  some  of  these  cases  show  disordered 
mind,  but  no  muscular  incoordination,  merely  becoming  confused 
mentally,  then  comat. 

Later  workers  rt-^ird  the  so-called  "gasolene  jag"  as  carbon 
monoxide  poisoning  of  mild  degree. 

A  feature  not  to  be  overlooked  is  the  making  of  urgent  repairs 


282  NAVAL  HYGIENE 

which  often  overtaxes  the  efforts  of  the  workers  which  are  put  forth 
under  bad  living  conditions.  The  crews  of  submarines  also  are  sub- 
jected to  considerable  exposure  due  to  wetting  as  the  result  of  running 
awash,  and  consequently  are  predisposed  to  tonsilitis,  rheumatic  and 
respiratory  infections. 

Injuries  through  machinery  are  common,  and  electrical  burns 
also  are  to  be  mentioned.  Burns  due  to  accidental  contact  with  sul- 
phuric acid  are  common,  as  the  acid  is  used  in  the  batteries.  As  result 
of  prolonged  exposure  to  unfavorable  living  conditions,  not  the  least 
of  which  is  the  inability  to  take  proper  exercise,  anemia  and  digestive 
disturbances  of  all  kinds  are  common  among  submarine  crews,  and 
the  lack  of  proper  laundry  facilities  as  well  as  facilities  for  personal 
cleanliness  predisposes  to  skin  infections  and  cellulitis. 

Conjunctivitis  is  commonly  caused  as  result  of  fumes  from  batteries. 
Prolonged  watch  at  the  periscope  is  apt  to  result  in  eye  strain,  but  there 
has  been  comparatively  little  complaint  concerning  eye  strain  of  this 
character  because  the  vessels  are  submerged  as  little  as  possible, 
running  on  the  surface  when  practicable. 

The  lack  of  appropriate  facilities  for  the  care  of  fresh  foods  greatly 
limits  the  choice  of  food  which  may  be  carried.  The  lack  of  variety 
and  the  difficulty  in  getting  fresh  food  tend  to  produce  digestive 
disturbances. 

The  preparation  of  food  is  difficult,  and  the  washing  of  mess  gear 
is  unsatisfactory  because  of  lack  of  fresh  hot  water. 

Men  detailed  for  submarine  duty  should  be  required  to  undergo 
an  extremely  rigid  physical  examination  with  special  reference  to  the 
nervous  system,  and  none  who  have  active  disease  or  whose  previous 
history  includes  syphilis  should  be  permitted  to  go  on  this  duty.  It 
should  be  remembered  that  the  facilities  for  caring  for  sick  on  board 
submarines  are  nil,  and  that  the  vessel  may  be  required  to  operate  at 
such  distance  from  base,  mother  ship,  and  hospital  ship  that  the  prompt 
transfer  of  sick  or  injured  could  not  be  effected.  Carriers  of  infectious 
disease  should  not  be  permitted  to  go  on  board  submarines. 

Surgeon  Kress,  U.  S.  Navy,  has  observed  in  several  cases  a  moderate 
albuminuria  which  he  attributes  to  inhalation  of  fumes  of  fuel  oil. 
These  cleared  up  promptly  after  a  few  days'  absence  from  what  was 
regarded  as  the  exciting  cause,  namely  the  fumes. 

An  "escape  apparatus"  has  been  devised  to  enable  escape  from 
submerged  submarines  which  are  unable  to  return  to  the  sirface. 


SUBMARINES  283 

The  essential  feature  of  this  dress  is  an  apparatus  which  permits  res- 
piration independently  of  atmospheric  air  just  as  the  so-called  "smoke 
helmet, "  or  the  shoal  water  diving  suit  in  use  by  the  Germans. 

The  accidents  to  submarine  boats  occasionally  result  in  loss  of  life 
even  of  the  entire  crew..  There  are  so  many  possibilities  that  it  seems 
remarkable  that  more  accidents  have  not  occurred.  For  instance, 
several  years  ago  the  Russian  submarine  Minoga  was  preparing  to 
submerge.  Some  signal  flags  lying  on  the  deck  and  across  the  coaming 
of  a  water-tight  hatch  prevented  the  complete  closure  of  the  hatch. 
When  the  boat  submerged  water  came  rapidly  in  through  the  partially 
closed  hatch  and  altered  the  trim  of  the  vessel  so  quickly  that  she  sank. 
After  submergence  of  about  nine  hours  the  entire  crew  was  rescued. 

The  German  submarine  U-3  about  to  submerge,  sank  as  result  of  en- 
trance of  water  through  a  ventilating  tube,  the  valve  of  which  was  not 
closed.  These  two  instances  are  cited  to  indicate  how  rapidly  disaster 
may  result  from  failure  on  the  part  of  the  personnel  to  perform  fully 
their  duties. 

Other  accidents,  as  in  the  case  of  the  U.  S.  S.  F-4,  have  occurred  in  for- 
eign navies  as  well  as  our  own,  and  the  causes  of  them  probably  will 
remain  among  the  mysteries  of  the  great  deep.  The  vessels  have  sub- 
merged and  have  not  come  to  the  surface.  When  the  vessels  have 
been  found  the  reasons  for  the  accidents  have  not  been  apparent, 
but  it  appears  very  probable,  except  in  time  of  war  when  submarines 
are  sunk  by  gun  lire  or  mines,  that  the  deaths  of  the  occupants  have 
been  due  to  suffocation  of  some  character. 


CHAPTER  XIX 

DIVING 

Diving  often  is  necessary  for: 

(a)  Recovery  of  human  bodies; 

(&)  Repairs  to  the  underwater  hull  of  a  ship; 

(c)  Clearing  of  propellers  which  have  been  fouled; 

(d)  The  recovery  of  torpedoes  during  target  practice; 

(e)  Recovery  of  lost  property. 

On  the  surface  of  the  water  the  diver  is  under  an  atmospheric 
pressure  of  14.64  pounds  per  square  inch,  or  "one  atmosphere."  In 
his  descent  he  subjects  himself  to  a  pressure  which  increases  directly 
in  proportion  to  his  depth  from  the  surface.  For  each  33  feet  of  vertical 
descent  below  the  surface  the  pressure  increases  "one  atmosphere," 
in  other  words  there  is  an  increase  of  about  15  pounds  pressure  per 
square  inch  for  each  33  feet  of  descent. 

Consequently  each  square  inch  of  body  surface  bears,  including  the  pressure  of 
the  air  at  the  surface,  approximately: 

A  pressure  of  30  pounds  (  2  atmospheres)  at  a  depth  of  33  feet; 
A  pressure  of  45  pounds  (  3  atmospheres)  at  a  depth  of  66  feet; 
A  pressure  of  60  pounds  (  4  atmospheres)  at  a  depth  of  99  feet; 
A  pressure  of  75  pounds  (  5  atmospheres)  at  a  depth  of  132  feet; 
A  pressure  of  90  pounds  (  6  atmospheres)  at  a  depth  of  165  feet; 
A  pressure  of  105  pounds  (  7  atmospheres)  at  a  depth  of  198  feet; 
A  pressure  of  120  pounds  (  8  atmospheres)  at  a  depth  of  231  feet; 
A  pressure  of  135  pounds  (  9  atmospheres)  at  a  depth  of  264  feet; 
A  pressure  of  150  pounds  (10  atmospheres)  at  a  depth  of  297  feet. 

To  meet  these  great  pressures  and  the  oxygen  exclusion  caused  by 
the  water,  man  must  resort  to  artificial  conditions  for  maintenance 
of  life  if  submergence  is  to  be  continued  longer  than  three  to  four 
minutes  and  if  considerable  depth  is  to  be  reached. 

In  the  pearl  fisheries  at  Hiqueru  in  the  South  Pacific  Ocean  I  witnessed  a  remark- 
able dive.  Upon  approaching  the  small  boat  from  which  the  diver  was  about  to 
descend  he  was  found  to  be  clad  in  a  loin  cloth  and  a  friendly  smile.  A  peculiar 

284 


DIVING  285 

moaning  sound  was  heard  which,  upon  arrival  at  the  boat,  was  found  to  be  due  to 
prolonged  noisy  expiration  after  deep  inhalation.  When  making  deep  dives,  the 
lungs  are  aerated  thoroughly  by  rapid  deep  inhalations  (the  expirations  producing 
the  moaning  sound  above  referred  to)  for  a  period  of  from  fifteen  minutes  to  one- 
half  hour.  During  this  period  rubbing  the  limbs  probably  facilitated  thorough 
oxygenation  of  the  tissues. 

\Vhen  about  to  dive  the  diver  took  a  very  deep  inspiration  immediately  before 
entering  the  water,  gently  lowered  himself  feet  first,  turned  in  the  water,  and  swam 
downward.  He  carried  a  small  piece  of  shell  not  so  large  as  the  palm  of  the  hand, 
usinj,'  it  to  detach  the  pearl  oyster  from  its  bed. 

He  descended  to  a  depth  of  seventeen  and  one-half  fathoms  (105  feet)  and  re- 
turned bringing  several  pearl  oysters  with  him  after  a  submergence  for  a  period  of 
two  minutes  and  forty-three  seconds. 

In  this  dive  no  untoward  symptoms  followed  the  brief  stay  of  the  diver  under  an 
absolute  pressure  of  about  60  pounds  per  square  inch. 

Hill  and  Flack  have  shown  that  forced  breathing  for  six  minutes 
results  in  ability  to  hold  the  breath  for  four  minutes  and  five  seconds. 
They  also  showed  the  "breaking  point"  to  be  when  the  partial  pressure 
of  alveolar  carbon  dioxide  equals  6  to  7  per  cent,  of  an  atmosphere 
and  the  oxygen  pressure  had  become  reduced  to  9  to  10  per  cent, 
of  the  atmosphere. 

Cloldfish  have  been  subjected  to  1000  pounds  pressure  (about  66.6  atmospheres) 
and  upon  release  of  pressure  were  limp,  but  after  a  short  time  adapted  themselves 
to  the  normal  atmospheric  pressure  and  swam  about  with  no  apparent  bad  results. 

This  tolerance  of  great  pressure  by  vital  tissue  is  shared  to  a  lesser  degree  by  man. 

l"nder  supervision  of  Surgeon  French,  U.  S.  Navy,  and  Chief  Gunner 
Stillson,  dives  to  a  depth  of  306  feet  were  made  about  the  wrecked 
submarine  U.  S.  S.  F-4,  near  Honolulu.  The  pressure  at  this  depth 
equals  7047  millimeters  of  mercury.  The  oxygen  partial  pressure 
amr un ted  to  1452  millimeters  of  mercury. 

Diving  in  deep  water  requires  that  the  diver  operate  in  a  diving 
(lre-s  which  in  principle  is  a  chamber  in  which  air  compression  and 
decompression  may  be  made  through  a  flexible  air  hose  communicating 
\\itl  the  air  pump  or  compressed  air  flasks  on  the  surface. 

The  diving  apparatus  consists  of: 

t.  A  rigid  helmet  and  chest  piece.  The  helmet  has  water-tight 
windows,  and  has  an  electric  light  and  telephone  attached; 

:>.  A  water-proof  dress,  being  elastic  and  fitting  snugly  at  the  wrist; 

•\.  Two  40-pound  lead  weights  for  front  and  back; 

4.  A  pair  of  weighted  boots  weighing  approximately  25  pounds  each; 

5.  A  life  line; 


286 


NAVAL  HYGIENE 


6.  A  wire-wrapped  flexible  air  tube  having  metal  couplings  con- 
necting the  diver's  helmet  with 

7.  The  air  pump  on  the  surface. 


FIG.  103. — Navy  standard  diving  dress.  Note  the  air  tube  leading  from  an 
air-pump  which  is  not  shown;  also  the  telephone  by  which  the  diver  may  speak 
to  an  operator  on  the  surface.  The  helmet  is  rigid  to  protect  the  head.  The  shoes 
are  heavily  weighted. 

The  total  weight  of  the  diver's  dress  exclusive  of  pump  and  air  tube 
is  about  175  pounds.  In  such  a  suit  a  man  at  rest  exhales  0.84  cubic 


DIVING  287 

foul  of  carbon  dioxide  per  hour  and  2.7  cubic  feet  when  at  work.     The 
resting  adult  breathes  about    15  cubic  feet  of  air  per  hour.     The  rate 
of  respiration   is  physiologically  adjusted  so  as  to  maintain  an  alve- 
olar tension  in  the  lungs  of  5  per  cent,  of  one  atmosphere. 
A.  satisfactory  diving  suit  must: 

1.  Remove  carbon  dioxide  and  exhalations  from  the  diver; 

2.  Supply  fresh  air  of  moderate  temperature; 

}.  Supply  the  air  with  increasing  pressure  as  the  diver  descends, 
equal  to  or  greater  than  the  water  pressure  surrounding  him,  and  must 
supply  a  volume  of  compressed  air  equal  in  volume  to  that  required 
by  the  diver  at  the  surface. 

Under  pressures  so  great  as  six  atmospheres  there  does  not  seem 
e  increase  of  carbon  dioxide  output  from  the  lungs.     When  the 
diver  is  at  rest  carbon  dioxide   should   not  be  permitted  to  increase 
within  the  diving  suit  to  a  tension  above  3  per  cent,  of  one  atmosphere, 
and  (luring  work  a  tension  of  not  more  than  i  per  cent,  of  an  at- 
mosphere   should   be   maintained  if  possible.     To   keep   the  carbon 
dioxide  at  3  per  cent,  he  should  have  (0.019  X  100  -f-  3  =  0.63  cubic 
;>er  minute)  and  during  work  (0.045  X  100  -s-  3  =  1.5  cubic  feet 
per  minute).     These  volumes  of  air  should  be  delivered  within  the 
diving  suit  on  the  surface. 

[n  descending  the  water  pressure  increases  one  atmosphere  for  each 

nu,  or  one  thirty-third  of  14.7  pounds  for  each  foot.     In 

order  to  withstand  the  water  pressure  air  is  delivered  within  the  diving 

suit  so  as  to  counterbalance  the  pressure  from  without  and  to  keep  the 

diver  from  being  squeezed. 

Following  Boyle's  law  the  volume  of  air  decreases  inversely  with 
the  pro-ure  upon  it,  therefore  a  cubic  foot  of  air  at  the  surface  would 
feet  below  the  surface  be  compressed  to  one-half  its  volume.     At 
el  or  an  absolute  pressure  of  three  atmospheres,  the  cubic  foot 
would  be  compressed  into  one-third  its  volume;  at  four  atmosph< 
fourth  its  volume,  and  so  on. 

On  the  surface  the  diver's  demands  are  about  15  cubic  feet  of  air 
per  hour.  This  volume  is  a  constant  and  must  be  maintained  regard- 
f  pressure.  In  other  words,  if  the  diver  is  surrounded  by  water 
whi<  h  is  producing  an  absolute  pre»ure  of  five  atmospheres  he  must 
be  supplied  with  15  cubic  feet  per  hour  of  air  compressed  to  five 
atmosphc 


288 


NAVAL  HYGIENE 


When  measured  at  the  surface  this  air  would  be  five  times  the  vol- 
ume for  the  surface  requirements  of  the  diver,  or  75  cubic  feet. 

He  must  receive  constantly  the  volume  (15  cubic  feet  per  hour)  of 
air  normally  required  by  the  adult  at  sea  level.  This  volume  of  air 


FIG.  104. — Diving  dress,  rear  view. 

must  remain  constant  no  matter  what  water  pressure  the  diver  goes  into. 
If  the  volume  must  remain  a  constant  as  the  pressure  increases  it  is 
evident  that  two,  three,  or  four  times,  and  so  on,  the  volume  of  his 


niviNi;  289 

illowance  on  the  surface  must  be  compressed  for  delivery  to  him  of  the 
necessary  volume  when  he  is  under  a.  corresponding  number  of  atmos- 
pheres of  water  pres>ure. 

It  is  desirable  that  the  air  pressure  within  the  diver's  suit  exceed  the 
water  pressure  on  the  outside  by  about  J^  pound.  This  condition 
gives  greatest  comfort  to  the  diver,  and  if  the  necessary  volume  of  air 
be  supplied  the  pressure  within  the  diver's  dress  may  be  regulated  by  a 
small  outlet  valve  which  is  placed  in  the  upper  part  of  the  dress,  either 
in  the  helmet  or  breast  plate.  It  has  been  found  more  comfortable 
to  have  this  outlet  valve  located  in  the  breast  plate  at  about  the  level 
of  the  shoulder. 

When  working  with  hands  above  the  head  sufficient  water  may  enter 
the  diver's  dress  at  the  wrists  to  cause  a  certain  amount  of  wetting 
and  chilling.  This  should  be  guarded  against  by  him. 

Excessive  inflation  of  the  diving  suit  is  undesirable  and  may  result 
in  the  diver  being  blown  to  the  surface.  This  accident  would  prove 
very  dangerous  to  life  if  he  were  blown  up  from  great  depth.  It  has 
been  found  best  to  put  a  lacing  around  the  legs  of  the  dress  to  prevent 
undue  inflation  which  might  result  in  the  diver's  inability  to  maintain 
his  equilibrium  as  result  of  buoyancy  of  his  lower  extremities.  Care 
must  be  exercised  that  the  diver's  signals  are  promptly  heeded,  for  in 
case  of  fall  of  considerable  vertical  distance  uncomfortable  if  not  danger- 
ous "squeeze"  might  result. 

In  the  deep  dives  made  about  the  U.  S.  S.  F-4  an  air  pump  was  not 
but  the  dress  of  the  diver  was  ventilated  with  air  compressed  in 
torpedo  flasks  from  which  it  was  supplied  through  a  manifold  and  con- 
trolled by  appropriately  placed  valves  and  gauges. 

A  diving  dre^s  has  been  devised  which  enables  the  diver  to  operate 

in  .-hoal  water  not  exceeding  33  feet  without  air-pump  connections,  and 

•  merely  a  life-line  attached.     This  dress  is  similar  in  character  to  the 

diving  dress  above  mentioned  except  that  instead  of  an  air  tube  and 

air-pump  connections  the  diver  carries  on  his  back  an  apparatus  which 

connects  with  the  interior  of  the  helmet.     The  apparatus  operates 

upon  the  principle  of  the  smoke  helmet  used  in  mine  rescue  work;  the 

air  ix  expired  through  certain  chemicals  which  abstract  the  content  of 

ure  and  carbon  dioxide,  and  the  oxygen  deficit  is  supplied  from  a 

tank  of  compressed  oxygen  which  is  appropriately  controlled. 

This  apparatus  enables  the  diver  to  remain  submerged  at  a  depth 
not  exceeding  about  35  feet  for  a  period  of  two  hours. 


2  QO  NAVAL  HYGIENE 

Hall  and  Rees  have  devised  a  dress  for  use  on  submarines  in  case 
of  accident,  its  purpose  being  to  enable  the  escape  from  the  submerged 
vessel.  The  essential  feature  of  the  dress  consists  in  an  incompressible 
helmet  having  an  air-tight  window  closed  with  glass  and  an  apparatus 
through  which  the  occupant  of  the  dress  exhales,  the  carbon  dioxide 
and  moisture  of  the  expired  air  being  absorbed  by  "oxylite,"  oxygen 
being  added.  The  principle  of  this  apparatus  is  similar  to  that  em- 
ployed for  the  maintenance  of  life  when  the  smoke  helmet  is  used.  It 
has  been  suggested  that  by  proper  weighting  this  dress  may  be  used 
for  diving  in  shallow  water. 

When  gases  are  compressed  in  the  presence  of  fluids  they  are  ab- 
sorbed by  the  fluids  until  a  point  of  saturation  is  reached.  The  body 
of  the  diver  presents  no  exception  to  this  rule.  His  blood  and  tissues 
absorb  the  compressed  air  to  a  point  of  saturation. 

If  the  diver  comes  to  the  surface  too  rapidly  his  body  tissues  and 
fluids  come  under  greatly  reduced  degree  of  pressure  and  his  condition 
is  analagous  to  that  of  a  charged  mineral  water  bottle.  The  sudden 
release  of  pressure  permits  the  rapid  expansion  of  the  compressed  air 
with  its  consequent  disrupting  effect  upon  the  tissues.  Fatty  tissues 
absorb  nitrogen  most  rapidly  and  give  it  off  rapidly.  Hence  this  con- 
stituent of  the  brain  and  nervous  system  is  apt  to  suffer  most  in  the 
disruptive  effects  caused  by  too  rapid  decompression. 

The  longer  the  diver  is  under  pressure,  the  more  dangerous 
decompression  becomes. 

The  diver  may  descend  as  rapidly  as  it  is  possible  to  deliver  the  air 
necessary  to  prevent  squeeze  during  his  progress,  but  his  ascent  must  be 
made  very  differently.  The  duration  of  it  will  depend  in  part  upon  the 
degree  of  pressure  to  which  he  has  been  exposed,  and  the  duration  of 
that  exposure.  It  has  been  shown  above  that  the  pearl  divers,  unaided 
by  diving  dress,  exposed  themselves  to  an  absolute  pressure  varying 
up  to  about  five  atmospheres,  and  after  remaining  under  such  pressure 
for  a  minute  or  two  returned  to  the  surface  and  often  experienced  no 
ill  effect.  A  similar  performance  may  be  repeated  in  the  diving  dress, 
but  if  the  diver  is  to  make  a  stay  of  any  duration  at  the  pressures  above 
mentioned  his  return  to  the  surface  cannot  be  immediate,  but  must  be 
made  by  stages,  and  with  delay  at  each  stage. 

It  has  been  found  that  if  the  tissues  are  saturated  at  a  given  abso- 
lute pressure  this  pressure  may  be  reduced  to  one-half  without  any 


ri-k,  hut  a  reduction  of  pressure  in  excess  of  one-half  the  absolute  pres- 

e  at  which  the  tissues  were  saturated  is  dangerous. 

A  diver  at  a  depth  of  99  feet  is  under  four  atmospheres  absolute 
pressure,  and  may  ascend  until  he  has  reached  half  way  to  the  surface, 
where  he  should  stop  to  enable  his  tissues  to  accommodate  themselves 
to  the  lowered  air  pressure  at  that  level  before  further  ascent.  While 
ascending  he  should  work  his  arms  and  legs  to  aid  in  the  expulsion  of 
the  nitrogen  from  the  tissues. 

Too  rapid  return  to  the  surface  following  prolonged  exposure  to 
pressures  greater  than  two  atmospheres  absolute  pressure  usually 
results  in  extremely  painful  and  dangerous  symptoms.  The  rapid 
liberation  of  nitrogen  gas  causes  the  formation  of  bubbles  of  nitrogen 
in  the  various  tissues  of  the  body.  The  effect  of  this  varies  with  the 
tissues  involved. 

In  the  milder  cases  the  first  symptoms  are  pains  in  the  muscles  and 
joints.  These  may  become  very  severe  and  embarrassment  of  breathing 
ard  heart  action  follow  as  result  of  bubbles  in  the  circulatory  system 
and  luni^.  Unconsciousness,  cyanosis  and  great  shock  appear.  There 
m  iv  be  marked  distention  of  abdomen.  Ecchymoses  may  appear. 
The  agonizing  pains  in  the  muscles  and  joints  have  given  this  condi- 
tion its  common  name,  "the  bends." 

The  more  dangerous  effects  are  manifested  upon  the  nervous  system. 
The  disruptive  action  of  the  liberated  nitrogen  may  strike  vital  centers 
and  result  in  immediate  fatality,  and  temporary  or  permanent  paraly- 
ses may  follow  immediate  destruction  of  motor  centers  or  injurious 
compression  resulting  from  hemorrhage. 

I' nder  ordinary  conditions  return  to  the  surface  should  never 
be  so  rapid  as  to  allow  symptoms  resulting  from  too  rapid  decom- 
ion.  If  for  urgent  reason  it  is  imperative  to  depart  from  the 
method  of  procedure  which  experience  has  shown  to  be  safe,  or  if  the 
diver  has  been  blown  up  to  the  surface  as  result  of  excessive  inflation 
of  his  dress,  he  should  be  "  recompressed "  immediately,  being  sent 
down  under  water  rapidly  upon  the  appearance  of  the  first  symptom  of 
"bends." 

A  recompression  chamber  on  base  ships  is  very  desirable  and  has 
proved  useful  in  the  British  Navy  during  the  war  now  in  progress. 

Men  who  are  to  engage  in  diving  should  be  selected  by  physical 
examination  of  severity  second  only  to  that  given  for  aviation  duty. 
Young,  wiry,  robust  individuals  should  be  selected.  The  condition 


292 


NAVAL   HYGIENE 


of  lungs,  heart,  blood-vessels  and  nervous  system  should  be  studied 
most  carefully.  Those  addicted  to  abuse  of  drugs,  alcohol  or  tobacco 
should  not  be  permitted  to  dive.  Persons  past  forty  years  of  age  and 
those  having  history  suggestive  of  sclerosis  of  blood-vessels  also 
should  be  eliminated.  Owing  to  the  rapidity  with  which  fat  absorbs 
nitrogen,  its  power  to  absorb  this  gas  in  much  greater  quantity  than 
other  tissues,  and  its  tendency  to  give  off  its  large  volume  of  absorbed 
nitrogen  rapidly,  fat  men  are  undesirable.  The  diver  should  be  young, 
strong,  lean,  and  free  of  organic  disease. 


CHAPTER  XX 
SWIMMING 

>ro\vning  causes  a  greater  number  of  deaths  in  the  United  States 
Xavy  in  time  of  peace  than  any  disease  or  accident.  It  caused  over 
19  per  cent,  of  the  deaths  in  the  United  States  Navy  during  the  seven 
\ears  from  1910  to  1916  inclusive.  (The  average  actual  number  of 
deaths  per  annum  was  299.5  and  of  these  drowning  claimed  57.5  men 
each  year.)  This  exceeds  by  far  the  next  greatest  cause  of  death  in 
the  Navy,  viz.,  tuberculosis.  Gatewood  says  that  28  per  cent,  of 
deaths  afloat  are  due  to  drowning. 

In  certain  cases  of  drowning,  for  instance  in  the  fatal  submergence 
of  the  U.  S.  S.  F-4,  it  is  probable  that  the  most  skilled  swimmer  could 
not  have  survived,  yet  it  is  not  improbable  that  the  annual  number  of 
deaths  due  to  drowning  would  be  reduced  materially  if  the  personnel 
of  the  service  were  possessed  of  a  greater  degree  of  excellence  and 
c  mfidenre  in  swimming. 

While  working  on  the  ship's  side  it  is  not  an  uncommon  occurrence 
for  men  to  fall  overboard,  and  even  a  slight  knowledge  of  swimming 
would  enable  them  to  stay  up  until  rescued. 

During  severe  winter  weather  in  New  York  a  side  cleaner  slipped  on  the  ice 

\\liic h  lay  on  the  armor  ledge  of  the  North  Dakota,  and  fell  into  the  water  below. 

Luckily  his  head  did  not  strike  any  of  the  large  masses  of  floating  ice  and  his  ability 

:n  en.-iblrd  his  rescue.     He  was  badly  shocked  by  fright  and  cold  when  brought 

in  for  treatment. 

•«  h  individual  in  the  naval  service  should  undergo  compulsory 
instruction  in  swimming  and  should  not  be  excused  except  upon 
certificate  of  medical  officer.  Persons  suffering  with  disease  of  ears, 
sinuses,  heart,  lungs,  or  kidneys  should  he  excused. 

While  instruction  in  swimming  should  be  compulsory  it  should 
be  gradual,  should  inspire  confidence,  and  should  not  be  of  character 
to  piodi:<  t'rii^bt.  especially  in  those  who  tend  toward  mental 

instability. 

293 


294 


NAVAL  HYGIENE 


While  serving  on  the  U.  S.  S.  North  Dakota  I  saw  a  case,  X,  in  which  mental 
imbalance  followed  fright  as  result  of  his  being  urged  to  jump  overboard  in  deep 
water  in  an  effort  to  qualify  in  swimming.  Being  unable  to  swim  and  unwilling  to 
make  objection,  he  jumped,  struggled  in  the  water,  was  rescued,  and  little  further 
was  thought  of  the  incident  until  swimming  call  was  sounded  the  following  day. 
This  call  was  for  voluntary  swimmers. 

Being  hurriedly  called  on  deck  to  treat  a  man  who  was  said  to  be  apparently 
drowned,  I  found  X  unconscious,  lying  on  the  forecastle  of  a  steam  launch  upon  which 
he  had  been  dragged  out  of  the  water.  He  was  partially  clad.  Eye  witnesses  said 
they  had  left  him  asleep  under  the  overhang  of  No.  i  turret  when  they  started  for 
their  afternoon  swim.  The  next  they  saw  of  him  was  when  he  was  recognized  as  a 


FIG.    105. — Swimming  drill.     Learning  leg  motions.      (Medical  Inspector  J.  A. 
Murphy,  U.  S.  N.,  in  United  States  Naval  Medical  Bulletin.) 

struggling  man  among  the  group  of  swimmers  and  apparently  drowning.  A  part 
of  his  clothing  was  found  near  turret  No.  i  where  he  had  removed  it  just  before  his 
plunge  into  the  water,  which  must  have  been  from  the  main  deck  or  from  the  deck 
of  the  ship's  forecastle,  distances  of  16  and  22  feet  respectively.  No  one  saw  him 
jump.  As  many  were  diving  from  the  ship  he  attracted  no  attention. 

He  was  resuscitated  but  remained  in  a  state  of  stupor  for  a  day  or  so,  and  when 
finally  he  became  conscious  it  was  evident  that  a  psychosis  had  come  to  the  surface, 
and  the  unfortunate  man  had  to  be  invalided  to  a  hospital  for  care  of  such  cases. 

Instruction  in  swimming  should  be  begun  out  of  the  water.  Where 
a  number  of  persons  are  to  be  instructed  a  dry  swimming  drill  will 
enable  them  to  acquire  the  proper  muscle  sense  and  execution  of  the 
necessary  movements.  The  first  drill  should  be  in  the  standing 
position. 


SWIMMING 


295 


296 


NAVAL  HYGIENE 


SWIMMING 


297 


After  the  proper  motions  of  arms  and  hands  are  learned  instructions 
may  be  given  to  the  pupils  lying  across  benches  on  their  abdomens. 
This  posture  simulates  more  nearly  that  of  the  swimmer  and  the 
exact  rhythm  of  leg  and  arm  motionSucan  be  learned  to  better  advantage. 

The  pupils  are  now  ready  to  ba  taken  into  water  shoulder  deep, 
where  sustained  by  floats  or  life  preservers  confidence  is  established, 
and  the  swimming  strokes  can  be  practised.  After  a  lesson  or  two  free 
swimming  should  be  begun,  the  instructor  keeping  careful  watch  that 
the  pupils  do  not  acquire  faulty  strokes  which  tend  to  retard  the  thrust 
and  cause  drag. 


1 08. — Learning  the  motions  of  both  legs.      (Murphy,   United  Stales  Naval 
Medical  Hull f tin.) 

Swimming  Tanks.—  If  possible  tin-  instruction  in  swimming  should 

;ven  in  the  pools  at  training  stations  before  the  individuals  are 

>ent  on  hoard^ship.     If  this  cannot  be  done  the  first  opportunity  should 

rized   to   teach    swimming.     No   diseased   person  or   carrier  of 

•ions  disease  should  be  permitted  to  enter  the  swimming  pool,  and 
all  persons  should  be  required  to  take  a  cleansing  shower  before  entering 
it.  Persons  having  sore  throats,  tonsilitis,  respiratory  or  skin  infec- 

>hould  not  be  permitted  to  enter  the  swimming  tanks. 
The   water  in    the  tanks  should   he  changed   as  often  as  possible. 
When  the  temperature  of  the  water  is  low  enough  to  require  that  the 
w.iter  he  heated,  the  rhanging  of  the  contents  of  the  pool  will  neces- 


298 


NAVAL  HYGIENE 


SWIMMING 


299 


300  NAVAL   HYGIENE 

sarily  be  less  frequent.  In  such  circumstances  the  water  should  be 
treated  with  calcium  hypochlorite  in  proportion  i  to  500,000.  Prob- 
ably this  is  best  applied  by  placing  calcium  hypochlorite,  containing 
not  less  than  30  per  cent,  of  available  chlorine,  in  gauze  bags  and  draw- 
ing them  through  the  pool. 

This  sterilization  should  occur  at  least  weekly,  since  the  warmed 
water  containing  epithelial  debris  from  the  bodies  of  the  bathers 
constitutes  an  excellent  culture  medium  for  pus  organisms.  This 
method  has  been  found  very  satisfactory  and  has  effected  practical 
sterilization  of  highly  infected  water. 

At  Brown  University  the  process  has  been  employed  most  satisfactorily  for  the 
purification  of  water  in  the  swimming  pool  of  the  gymnasium.  For  some  reason 
it  was  found  impracticable  to  refill  the  tank  oftener  than  once  every  three  months. 
Obviously  such  infrequent  change  of  the  water,  which  probably  was  heated,  and 
which  would  acquire  pabulum  sufficient  to  maintain  bacterial  life  from  decom- 
posing epithelial  scales,  etc.,  derived  from  the  swimmers,  would  be  a  great  source  of 
danger  provided,  for  instance,  the  water  became  polluted  by  a  typhoid  carrier. 
Chemical  purification  was  desirable  and  the  hypochlorite  method  was  employed. 
It  is  said  that  water  containing  500  organisms  per  cubic  centimeter  was  sterile 
one  hour  after  employment  of  the  method. 

Whether  in  the  pool  or  elsewhere  swimming  should  not  be  per- 
mitted if  the  temperature  is  below  7o°F.,  and  if  the  temperature  of  the 
water  is  below  85°  swimming  for  a  period  longer  than  fifteen  minutes 
should  not  be  allowed. 

With  reference  to  meal  hours,  swimming  before  meals  is  preferable, 
and  after  meals  should  not  be  indulged  in  within  two  hours.  In  the 
tropics  it  is  desirable  that  swimmers  enter  the  water  while  the  sun  is 
low,  either  before  9:00  a.m.  or  after  4:00  p.m.  in  order  to  prevent  the 
severe  sunburns  often  resulting  from  exposure  to  the  intensity  of  the 
sun's  rays. 

High  dives  are  dangerous  and  injury  is  apt  to  follow  their  attempts 
by  unskilled  swimmers.  During  the  flight  through  the  air  the  would- 
be  diver  often  changes  position,  so  that  instead  of  breaking  the  water 
with  the  tips  of  his  fingers  and  the  body  following  arrow  fashion,  he 
falls  in  such  way  as  to  strike  dorsal,  lateral,  or  ventral  surfaces  of  the 
body  upon  the  incompressible  water,  and  the  consequent  shock  may 
result  in  unconsciousness  and  drowning.  Those  making  high  dives 
very  commonly  suffer  muscle  strains  and  bruising. 

The  sudden  change  of  pressures  as  result  of  diving  is  apt  to  cause 
ear  disease.  Infections  of  the  middle  ear  are  very  common  among 


SWIMMING  3OI 

swimmers  and  may  be  prevented  in  part  by  the  insertion  into  the  ears 
.if  i  niton  which  has  been  soaked  in  sweet  oil,  albolene,  vaseline,  or 
some  other  bland  oily  substance.  This  will  prevent  the  entrance  of 
water  into  the  external  auditory  canal,  but  of  course  cannot  prevent 
the  admission  of  sea  water  to  the  middle  ear  through  the  eustachian 
tubes. 

When  ships  are  at  anchor  in  a  harbor  near  a  city  swimming  should 
be  permitted  only  during  flood  tide,  preferably  just  before  the  turn,  in 
order  that  the  sewage  from  the  city  may  be  avoided  when  it  is  carried 

by  the  ebb. 

Also  all  water  closets  and  bathrooms  emptying  from  the  side  of 
the  ship  along  which  swimming  is  to  take  place  should  be  closed  at 
least  for  one"-half  hour  before  the  water  is  entered  and  during  the  time 
that  the  swimmers  are  in  the  water. 

Swimming  from  the  ship  should  be  restricted  to  short  distances, 
and  a  life  boat  containing  an  expert  swimmer  should  be  lowered  before 
persons  are  permitted  to  enter  the  water. 

The  boat's  crew  should  be  carefully  trained  in  the  resuscitation  of 
the  apparently  drowned.  Life  preservers  and  life  lines  should  be  made 
ready  on  the  deck  of  the  ship,  and  men  should  be  detailed  to  stand  by 
to  throw  them  promptly  in  case  of  apparent  danger  to  any  swimmer. 

The  grab  line,  which  extends  almost  the  entire  length  of  the  ship, 
should  be  lowered  until  it  is  awash  and  should  be  shored  from  the 
ship's  side  or  guyed  from  the  boat  booms  so  that  it  is  well  clear  of  the 
s'nK  in  order  that  the  line  may  be  grabbed  easily,  and  that  swimmers 
seeking  its  aid  may  not  be  cut  by  barnacles  which  may  be  growing 
upon  the  ship's  side. 

Prolonged  stay  in  cold  water  tends  to  produce  cramps  in  muscles 
of  the  extremities  and  abdomen.  This  may  well  result  in  the  drowning 
trong  swimmer  if  help  is  not  at  hand. 

Unauthorized  swimming  should  be  prohibited.  In  strange  locali- 
unobjectionable  local  conditions  should  be  established  before 
swimming  is  allowed. 

For  years  it  was  the-  custom  to  permit  daily  swimming  alongside  the  German 

training  ships  which  lay  in  the  Kiel  Canal  quite  close  to  land.     During  one  summer 

I   piuumonia   with   suppuration    (Lungenbrand)   developed.     The 

,il   nilkvr   of    the   hrig   Rover  noticed  one   day  that  a  large  pus-saturated 

bandage  was  discharged  into  the  water  from  the  mouth  of  a  sewer  which  emptied 

in  the  vicinity  of  the  brig.     This  sewer  also  carried  the  sewage  from  the  university 


302 


NAVAL   HYGIENE 


hospital.     Swimming  alongside  was  forbidden,  and  lung  suppurations  no  longer 
occurred. 

Swimming  in  land-locked  harbors  should  not  be  allowed  especially 
if  many  vessels  are  at  anchor  or  much  sewage  is  discharged  into  the 
harbor.  The  pollution  of  the  water  in  such  harbors  may  be  increased 
as  result  of  ships  bringing  water  ballast  from  infected  harbors  and  dis- 
charging it  at  the  port  of  arrival. 

Swimming  about  the  mouths  of  rivers  may  be  especially  dangerous. 
The  International  Joint  Commission  on  the  Pollution  of  Boundary 
Waters  reported  concerning  the  water  at  the  mouths  of  the  Detroit 
and  Niagara  Rivers  that  "serious  pollution  extends  over  10  miles 
into  the  lake  receiving  the  discharge." 


CHAPTER  XXI 
RESUSCITATION  OF  APPARENTLY  DROWNED 

The  Surgeon  General's  report  for  the  year  1917  shows  that  drown- 
ing heads  the  list  of  causes  of  death  in  the  Navy  as  it  has  for  several 
years  past.  During  1917  seventy-four  deaths  from  drowning  (five 
of  which  were  suicidal  and  thirty-six  due  to  the  disaster  to  the  U.  S.  S. 
Memphis)  occurred.  Such  common  cause  of  death  in  the  Navy  calls 
not  alone  for  special  instruction  in  swimming  but  also  requires  that 
each  member  of  the  naval  personnel  be  thoroughly  instructed  in 
methods  for  resuscitation  of  the  apparently  drowned.  These  methods 
are  (a)  manual  and  (b)  mechanical. 

(a)  Manual. — The  Schaefer  method  is  the  best  of  the  several 
manual  methods  which  have  been  devised  for  resuscitation  of  the 
apparently  drowned.  This  method  or  any  other  effort  to  resuscitate  the 
apparently  drowned  should  be  commenced  at  the  earliest  possible 
instant.  No  second  should  be  lost,  for  it  must  be  borne  in  mind 
that  complete  submergence  for  a  period  longer  than  five  minutes 
usually  has  fatal  result.  A  maximum  of  speed  consistent  with  per- 
formance of  the  work  at  hand  is  a  desideratum. 

In  the  Schaefer  method  the  following  steps  should  be  carried  out: 

1 .  Remove  patient  from  water  and  commence  without  delay,  ashore, 
in  boat,  on  raft,  or  on  board  ship; 

2.  Loosen  the  collar,  and  if  in  warm  place  strip  the  chest  hurriedly; 

3.  Roll  patient  over  so  that  he  rests  on  ventral  surface  of  body; 

4.  Step  astride,  and  with  hands  clasped  under  his  abdomen,  raise 
the  body  and  shake  thoroughly  in  effort  to  expel  water  from  upper 

-atory  tract  and  stomach; 

5.  With  patient  still  face  down  turn  head  to  one  side  and  wipe  out 
rmuth  and  pharynx  with  handkerchief  or  any  available  fabric;  in  its 
absence  hurriedly  sweep  mucus  out  of  pharynx  with  finger,  leaving 

LI  e  turned  to  one  side; 

6.  While  clearing  the  mouth  draw  tongue  forward; 

7.  Extend  the  arms  forcibly  above  the  head  leaving  them  in  this 

303 


3°4 


NAVAL  HYGIENE 


position.     Forced  extension  of  the  arms  places  the  chest  in  a  state  of 
extreme  distention. 


FIG.   in. — The    Schaefer    method  of    resuscitation  of  the  apparently  drowned. 
Attempting  to  expel  water  from  naso-pharynx  and  upper  respiratory  tract. 

If  the  foregoing  instructions  have  been  followed  the  patient  will  be 
lying  prone  with  arms  extended  well  above  the  head  and  face  turned 
to  one  side.  The  operator  should  now: 


FIG.  112. — Schaefer  method.     Forcibly  extending  the  upper  extremities   places 
the  chest  in  a  state  of  permanent  distention. 

8.  Kneel  astride*the  subject  at  a  level  of  the  iliac  crests  of  the 
latter,  and  placing  both  hands  upon  the  lower  posterior  part  of  the 


RESUSCITATION   OF    APPARENTLY   DROWNED 


305 


thorax,  with  thumbs  parallel  to  the  spinal  column  and  fingers  extending 
over   thr   lower    ribs,  should   make    rhythmic    pressure   at    a    rate  not 


FIG.  113. — The  Schaefer  method.  The  operator's  hands  are  placed  over  the 
lower  ribs  posteriorly.  A  blanket  or  rolled  coat  under  the  epigastrium  will  make 
cot  nterpressure. 

•ling   fifteen    times  per   minute.     This  pressure   should  not  be 
violent  but  should  be  exerted  upon  the  hands  by  the  weight  of  the 


\ 


•  •    114- — The   Schaef<  orator  leans  forward,  throwing  the 

t  of  his  body  upon    his    hands    and    without    removing    his    hands   returns 
to  the  position  shown  in  the  preceding  figure. 

operator  merely  leaning  forward     not  squeezing.     Violence  may  cause 
fracture  of  ribs.     (A  coat  or  blanket  rolled  and  placed  under  patient's 


306 


NAVAL   HYGIENE 


epigastrium  will  aid  in  making  counterpressure  when  the  thorax  is 
compressed.) 

9.  If  the  subject  commences  to  breathe  the  efforts  at  resuscitation 
should  be  continued,  and  careful  watch  should  be  kept  upon  the 
patient's  respirations  until  it  is  evident  that  the  function  has  become 
definitely  established; 

10.  If  oxygen  inhalations  are  available,  they  should  be  admin- 
istered at  once; 

11.  Usual  treatment  of  shock  should  follow; 

12.  Where  there  is  even  remote  possibility  of  resuscitation  effort 
should  be  continued  for  four  to  six  hours,  since  patients  apparently 


FIG.   115. — The    Sylvester  method.     The   operator  pulls  the   arms  well   over  the 

head. 

drowned  have  commenced  to  breathe  after  several  hours  of  persever- 
ing effort  at  resuscitation.  Do  not  give  up  too  soon. 

The  Sylvester  method  of  resuscitation  of  the  apparently  drowned 
is  an  older  method  which  is  more  laborious,  and  usually  requires  an 
assistant. 

The  subject  should  be  shaken  and  the  mouth  and  nose  cleared  as 
described  in  the  Schaefer  method.  After  this  the  patient  is  rolled  on 
his  back,  the  tongue  is  grasped  and  pulled  forward  by  the  assistant 
who  holds  it  in  this  position  to  prevent  its  falling  backward  and  closing 
the  glottis. 

The  operator,  kneeling  at  the  patient's  head,  seizes  his  forearms 
near  the  wrists,  lifts  them  up,  extending  them  well  above  the  patient's 


RESUSCITATION   OF   APPARENTLY   DROWNED 


307 


,  then  brings  them  down  in  such  manner  that  the  forearms  are 
•  1  at  the  elbow  and  the  lower  portion  of  the  chest  is  compressed  by 
the   operator's  pressure  upon  the  forearms  and  chest.     This  should 
be  repeated  about  fifteen  times  per  minute. 

The  following  disadvantages  are  apparent  in  the  Sylvester  method: 

1 .  Two  persons  are  constantly  necessary  for  its  successful  perform- 
ance,  else  the  glottis  may  be  closed  by  the  tongue  falling  backward; 
tying  it  out  with  string  around  tongue  and  lower  jaw  is  unsatisfactory; 

2.  The  position  of  the  patient  is  such  that  any  mucus  or  water 
accumulating  in  the  pharynx  will  not  be  expelled  by  gravity,  but  must 
be  wiped  out; 


l:u;.   116. — The  Sylvester  method.     Making  compression  upon  the  lower  thorax. 

3.  The  work  of  the  operator  is  so  laborious  that  maintenance  of 
artificial  respiration  with  this  method  is  extremely  difficult  without 
frequent  relief-. 

The  Seluiefer  method  is  the  method  of  choice.  It  effects  an  ex- 
change of  over  50  per  cent,  of  the  tidal  air,  or  about  225  c.c.  at  each 
respiration. 

(b)  Mechanical  devices  for  the  maintenance  of  artificial  respiration 
have  been  placed  on  the  market.  They  range  from  the  pulmotorto 
the  plumber's  plunger.  My  experience,  observation  and  information 
lead  to  the  belief  that  the  employment  of  such  apparatus  seldom  is 
efficacious  if  it  is  not  actually  harmful. 

Great  danger  attends  the  use  of  apparatus  which  induces  a  partial 


308  NAVAL   HYGIENE 

vacuum  during  the  expiratory  stage.  Recoveries  do  not  follow  the  use 
of  apparatus  for  maintaining  artificial  respiration  after  the  subject 
ceases  to  breathe  spontaneously;  consequently,  manual  effort  really  is 
all  that  is  required  to  supplement  Nature's  enfeebled  performance  of 
function. 

Perhaps  the  best  of  all  apparatus  used  in  efforts  to  resuscitate  the 
apparently  drowned  is  the  lung  motor.  It  may  be  used  whenever 
artificial  respiration  should  be  employed. 

The  apparatus  enables  the  administration  of  air  alone  or  a  mixture 
of  air  and  oxygen,  the  latter  being  generated  in  an  apparatus  specially 
devised  for  the  purpose. 

The  lung  motor  has  certain  perishable  (rubber)  parts,  and  like 
all  other  apparatus  for  keeping  up  artificial  respiration,  requires  con- 
stant inspection  as  to  its  efficiency. 

Too  commonly  apparatus  of  this  character,  complicated,  requiring 
skilled  operator,  and  composed  in  part  of  perishable  (rubber)  parts,  is 
so  far  away  from  the  point  where  it  is  needed  that  manual  efforts  must 
be  resorted  to,  and  by  the  time  the  mechanical  apparatus  can  be 
available  the  issue  of  life  or  death  already  has  been  settled. 

Persevering  employment  of  the  Schaefer  method  (especially  if 
oxygen  inhalations  are  administered  simultaneously)  will  accomplish 
ah1  that  may  be  hoped  for  in  the  use  of  mechanical  devices.  It  may 
be  instituted  at  once.  It  is  immediately  available.  If  respiration 
spontaneously  exists  or  has  become  established  by  manual  effort,  it  is 
unwise  to  resort  to  the  doubtful  expedient  of  employing  apparatus 
even  if  it  is  at  hand. 

If  spontaneous  respiration  is  occurring  the  patient  should  be 
watched  for  several  hours  until  he  is  thoroughly  conscious,  to  insure 
that  breathing  is  continued.  The  usual  treatment  for  shock  should 
be  employed;  namely,  stimulants  and  applications  of  heat. 


CHAPTER  XXII 
MARINE  ANIMAL  LIFE  DANGEROUS  TO  MAN 

Animal  life  in  the  water  may  prove  a  menace  to  man.  Authentic 
ristances  of  injury  to  nava)  personnel  have  been  reported  as  result 
'  bites  believed  to  have  been  those  of  man-eating  sharks. 

The  reports  of  activity  of  a  man-eating  shark  along  the  Atlantic 
"oast  during  the  summer  of  1916  have  been  chronicled,  especially 
11  the  New  Jersey  Coast. 

The  reason  for  this  is  not  apparent.  Since  sharks  are  fond  of  gar- 
age it  seems  probable  that  the  decrease  in  the  number  of  trans- 
llantic  ships  lessened  their  food  supply,  and  this  individual  sought 
)od  near  the  big  cities  along  the  coast. 

Fish  may  be  harmful  to  man  as  result  of: 

I.  Ingestion  of  flesh  containing  products  poisonous  to  man; 

II.  Bites  or  stings  by  venomous  fish; 

III.  Grand  trauma,  e.g.,  shark  bite  or  powerful  blow  by  the  tail  of 
ih; 

IV.  Postmortem  decomposition. 

I.  Ingestion  of  Flesh  Containing  Products  Poisonous  to  Man. 
Fish  living  in  coral  reefs  often  are  dangerous  and  should  not  be  eaten 
except  on  advice  of  natives,  and  after  feeding  tests  on  dogs  if  possible. 
A  fish  found  in  Japan  called  fugu  is  very  poisonous  and  Scheube  states 
that  the  natives  often  use  it  in  committing  suicide.     This  fish  belongs 
to    the   genus    Tctraodon.     The   poison    is   found   in   the  ovaries  and 
les.     The  symptoms  appear  rapidly  after  eating  the  fish  or  the 
and  consi-t    of   nausea,    abdominal   pains,  severe  headache  and 
collapse.     Death  may  occur  within  a  few  hours  as  result  of  paralysis, 
cardiac  or  respiratory. 

The  Muki-Muki  or  Tetraodon  hispid  us  is  poisonous  and  is  referred 
to  in  Hawaii  as  the  " death  fish." 

309 


3io 


NAVAL  HYGIENE 


The  following  are  important  species  which  are  poisonous: 


Tetraodon  hispidus 
Tetraodon  lunaris 
Spheroides  stictonotus 
Spheroides  vermicularis 
Spheroides  hypselogencis 


Spheroides  rubripes 
Lagocephalus  lavigatus 
Spheroides  chrysops 
Canthigaster  rivulatus 
Spheroides  pardalis 


Symptoms  following  ingestion  of  the  flesh  of  fish  should  be  imme- 
diately treated  by  emptying  the  stomach  and  stimulation. 


Swellftsh  or  Puff  Toad 

cTelraodon) 


paena 
gramiicornis 


Greater  "Weever   or    SI  indbull 
<  Trachinus   di-aco  i 


ft  +        ^ 

^^^^^W^'^^^r^^^^M 

^ili-^5^ 


Barracuda 


FIG.   117. — Poisonous   fishes.     The   sting-ray   or  trygon   belongs   to   the   Dasy- 
batidos.     (From  Stilt.) 

Occasionally  fish  are  brought  up  from  considerable  depth,  for 
instance  several  hundred  fathoms.  Ttese  animals  are  repulsive  in 
appearance,  are  swollen  as  result  of  release  of  pressure  at  great  depth, 
have  large  heads  from  which  their  bodies  taper  to  a  comparatively 
small  point,  the  end  of  which  is  terminated  by  the  characteristic  fish 
tail.  The  flesh  of  these  animals  is  translucent  and  their  general  repul- 
sive appearance  causes  them  to  be  uninviting  as  food  stuff. 


1 


[AR1NE   ANIMAL   LIFE   DANGEROUS   TO   MAN  311 

Surgeon  W.  W.  Hargrave,  U.  S.  Navy,  reports  that  barracuda,  goatfish  and 
yellowback  are  believed  to  be  poisonous  by  the  natives  of  Grand  Cayman,  B.  W.  I. 
Symptoms  appear  early,  the  first  effect  being  upon  the  sensory  nervous  system. 
Tingling  of  fingers  and  nose,  itching  or  pricking  of  the  skin  appear  and  are  followed 
by  violent  gastro-intestinal  symptoms.  Other  symptoms  are  prostration,  general 
body  pain,  headache,  lacrimation,  photophobia,  blurred  vision,  and  constant  desire 
to  void  urine.  The  natives  regard  cases  in  which  there  is  no  vomiting  as  very  serious , 
and  think  that  the  earlier  the  vomiting  the  better  the  prognosis.  The  duration  of 
the  incapacity  varies  in  some  cases,  extending  over  considerable  periods,  sometimes 
even  weeks. 

Oudard  has  reported  the  occurrence  of  70  cases  of  poisoning  result- 
ing from  eating  the  fish  in  China  called  Scioena  sina.  (Archives  De 
Medicine  Xavale,  No.  7,  1909.) 

This  fish  is  not  regarded  as  poisonous.  It  is  possible  that  it  be- 
comes so  at  certain  periods  during  the  development  of  organs  of 
generation.  The  poisoned  persons  suffered  violent  gastro-intestinal 
symptoms  and  shock  with  dilated  pupils. 

In  China  and  some  other  parts  of  the  world  the  custom  of  poisoning 
fish  has  been  in  vogue.  Croton  tiglium  and  other  poisons  have  been 
used.  There  is  a  possibility  that  these  fish  had  been  poisoned  instead 
of  being  caught  by  the  usual  methods  employed  by  fishermen. 

Mollusks  and  crustaceans  may  cause  poisoning  (see  "Oysters"  and 
"Clams"). 

II.  Bites  or  Stings. — The  following  is  a  classification  of  venomous 
iisli : 

(a)  Those  whose  bite  is  poisonous; 

(b)  Those  having  poison  glands  which  connect  with  spines; 

(c)  Those  producing  a  poison  in  their  skin  glands. 

(a)  The  bite  of  any  fish  may  result  in  dangerous  infection  as  result 
of  presence  of  infecting  organisms,  but  these  must  be  differentiated 
from  fish  possessing  venom  apparatus  which  poisons  when  the  fish 
bites.  The  genus  Murtwia,  of  which  there  are  more  than  a  hundred 
ies,  may  be  taken  as  a  type  of  this  class.  Severe  bites  may  be 
inflicted  by  their  strong  teeth. 

These  fish  have  a  poison  gland  just  above  the  palate,  mucous  mem- 
brane covering  the  gland  and  the_three  or  four  erectile  teeth  which  are 
connected  with  the  poison  gland.] 

When  a  bile  is  inflicted  tin-  poismi  llo\v>  down  the  teclh  into  the 
wound.  The  Miirccna  are  found  in  tropical  and  sub-tropical  waters^ 


312  NAVAL    HYGIENE 

(£)  Those  Having  Poison  Glands  Which  Connect  with  Spines.— 

Bottard's  classification  divides  this  class  into  three  groups. 

1.  Fish  whose  poison  apparatus  is  entirely  closed.     Rupture   of   a 
membrane  is  necessary  before  the  poison  can  escape. 

Synanceia  verrucosa 
Plotosus  anguillaris. 

These  fish  are  found  widely  distributed  in  the  waters  of  the  tropical 
Pacific.  In  Tahiti  the  natives  fear  them.  Synanceia  is  a  type.  The 
many  species  of  Synanceia  possess  dorsal  fins,  the  spines  of  which 
connect  with  pisoon  glands. 

When  the  fish  is  struck  by  human  skin  the  spines  enter  the  flesh 
and  the  poison  enters  the  wound. 

Excruciating  pain  follows  with  swelling.  If  the  amount  of  poison 
is  sufficient,  death  may  occur.  Septicemia  or  sloughing  may  occur. 

2.  Fish  whose  poison  apparatus  is  partly  closed. 

Thalassophryne  reticulata 
Thalassophryne  maculosa. 

Thalassophryne  reticulata,  Gunther  and  T.  maculosa,  Giinther,  the 
former  from  Panama  and  the  latter  from  the  Gulf  of  Bahia,  are  typical 
of  this  subdivision. 

Their  poison  apparatus  consists  of  two  parts :  (a)  a  hollow  barb  and 
poison  gland  on  the  gill  covers ;  and  (b)  a  similar  apparatus  on  the  dorsal 
aspect  of  the  fish  near  the  head. 

The  hollow  barbs  connect  with  the  poison  glands  and  when  the 
barb  sinks  into  the  flesh  of  a  victim  the  poison  flows  out  of  the 
channel  into  the  wound.  The  nature  of  the  venom  is  unknown. 

Calmette  regards  the  poison  apparatus  of  Opsanus  tau  of  North 
American  waters  and  Marcgrama  grunniens  found  in  the  Antilles,  as 
identical  with  that  of  Thalassophryne. 

3.  Fish  having  poison  apparatus  more  or  less  directly  communicating 
with  the  exterior. 

Trachinus  draco  Callionymus  lyra 

Trachinus  radiatus  Scorpana  porcus 

Trachinus  araneus  Scorpcena  scrofa 

Myoxocephalus  scorpius  Pelor  filamentosum 

Myoxocephalus  bubalis  Uranoscopus  scaber 

Coitus  gobio  Trigla  hirundo. 


ARFXE    ANIMAL    LIFE    DANGEROUS    TO    MAN  313 


Trachinus  draco  lives  in  the  sand,  is  apt  to  come  in  contact  with 
swimmers  and  is  a  type  of  this  group.  It  has  a  barb  on  the  operculum 
and  one  on  the  dorsal  fin.  Each  of  these  is  grooved  and  connected 
wi'h  its  poison  gland.  A  membrane  covers  the  groove  upon  the  barb, 
thus  making  a  canal  through  which  the  poison  enters  when  the  barb 
pierces  the  flesh  of  an  animal. 

The  poison  causes  extreme  pain,  numbness,  swelling,  sense  of 
sulTocation,  and  in  some  cases  syncope,  delirium  and  death.  It 
•ibles  snake  venom  in  its  effects.  Dunbar-Brunton  states  the 
flesh  of  this  group  is  edible. 

(c)  Of  the  Elasmobranchii  only  two  cause  poisonous  symptoms; 
namely,  the  Dasybatida  or  sting  ray,  and  the  MyliobatidcB  or  eagle  ray. 
Both  of  these  have  a  barb  attached  to  the  tail  and  produce  a  poisoned 
wound  when  they  sting.  They  have  no  poison  gland  and  it  is  believed 
that  the  venom  is  secreted  by  the  glands  of  the  skin.  Their  sting  is 
painful  and  causes  much  swelling.  In  some  cases  abscess  and  slough- 
ing occur. 

The  ^ting  of  these  fishes  does  not  usually  cause  death.     The  rays 

arc  found  in  tropical  and  sub-tropical  waters.     Those  of  the  northern 

of  South  America,  especially  at  the  mouth  of  the  Orinoco  River, 

an   said  to  be  unusually  venomous  and  to  be  capable  of  producing 

death  in  forty-ei^ht  hours. 

The  treatment  of  injuries  produced  by  poisonous  fishes  resembles 
that  of  snake  bite,  namely: 

(a)  Prevent  entrance  of  poison  into  the  general  circulation; 

(b)  Neutralize  the  poison  locally  if  possible; 

(c)  Stimulate  and  treat  symptomatically. 

Those  swimming  in  shoal  water  in  the  sub-tropical  and  tropical 
climates  are  liable  to  injury  by  contact  with  sea  urchins  (echinodenns) . 
Tlu'-e  animals  are  covered  with  spikes  sometimes  several  inches  long. 

Th-.1  spikes  are  calcareous,  very  frangible,  and  coated  with  a  transparent 

i  instance.     They   are   very   sharp-pointed  and   readily  enter 

kin  of  the  swimmer  who  OMIH-S  into  contact  with  them.     Their 

briitleness  causes  them  to  break,  leaving  a  calcareous  mass  with  its 

proteid  covering  in  the  flesh  of  the  swimmer. 

While  tiu-  writer  was  serving  on  the  Bancroft  in  Torto  Kit o  a  swimming  party 

n  rontart  with  a  he<l  of  tlu-e  animal-  a-  they  were  growing  in  shoal  water  on 

the  beach.     Several  men  were  injured.     The  worst  injury  was  that  of  an  individual 


314  NAVAL   HYGIENE 

who,  endeavoring  to  avoid  one  sea  urchin,  fell  into  a  collection  of  them,  wallowing 
as  would  a  horse.  He  suffered  much  pain  during  the  process  of  removal  of  the  many 
spines  which  had  entered  his  back  and  legs  and  was  incapacitated  for  duty  for  a 
number  of  days  as  result  of  his  accident. 

Medical  Inspector  W.  S.  Pugh,  U.  S.  N.,  reports  a  case  of  injury 
resulting  from  contact  with  a  sea  urchin  near  Corinto  in  Nicaragua. 

The  man  was  bathing  in  the  surf,  felt  a  prick  in  the  sole  of  his  left 
foot,  and  thought  he  had  stepped  on  a  shell.  In  a  few  moments  he 
became  giddy,  was  conscious  of  swelling  of  face  and  eyelids,  and  came 
out  of  the  water,  but  was  so  weak  that  he  could  not  walk  unaided. 

When  examined  his  face  was  found  to  be  dark  red  and  swollen, 
pulse  very  irritable,  varying  from  70  to  120  in  a  very  short  period  of 
time.  There  was  anaesthesia  of  the  anterior  surfaces  of  legs  and  arms 
with  almost  complete  motor  paralysis  of  both  legs.  The  plantar 
surfaces  of  the  left  foot  showed  six  small  punctures  from  which  were 
extracted  the  spines  of  a  sea  urchin.  These  were  so  brittle  that  they 
had  to  be  removed  in  pieces. 

The  nervous  and  vasomotor  symptoms  cleared  in  about  twenty- 
four  hours,  and  the  wounds  were  healed  in  five  days. 

Jelly-fish,  "sea  nettles"  (Tr  achy  medusa) ,  are  disagreeable  swim- 
ming companions.  Along  the  northern  coasts  of  the  United  States  con- 
tact with  jelly-fish  commonly  results  in  the  production  of  erythematous 
welts  at  the  point  of  contact,  with  considerable  burning  and  pain, 
but  constitutional  symptoms  are  seldom  observed,  although  they  do 
appear  occasionally.  It  seems  probable  that  the  size  of  the  dose  of 
poison  from  the  jelly-fish  has  much  to  do  with  the  constitutional  effect, 
as  fishermen  and  other  adults  do  not  experience  severe  constitutional 
effects,  in  part  because  the  dose  is  not  sufficiently  large. 

It  will  be  observed  that  the  fatal  case  mentioned  below  was  that  of 
a  fourteen-year-old  Filipino  boy.  The  adult  Filipino  is  small  and 
of  course  this  boy  had  not  a  large  body  to  be  influenced  by  the  dose  of 
poison  which  he  received.  In  the  case  of  Miss  Y,  also  mentioned  below, 
the  body  weight  was  not  over  100  pounds. 

The  variety  or  varieties  of  jelly-fish  producing  poisonous  effects  are 
unknown. 

Miss  Y,  while  bathing  at  Piney  Point,  Md.,  in  1916,  was  stung  on  the  left  cheek 
by  a  jelly-fish.  There  was  marked  prostration  which  comp3lled  her  to  go  to  bed 
for  several  hours.  She  states  that  she  felt  "all  in."  Beyond  the  depression  nothing 
was  noticed  except  the  pain  and  swelling  of  the  left  cheek  and  eye. 


MARINE   ANIMAL   LIFE   DANGEROUS    TO   MAN  315 

In  the  tropics  jelly-fish  (Tr  achy  medusa)  cause  serious  symptoms 
in  adults. 

Surgeon  E.  H.  H.  Old,  U.  S.  Navy,  has  reported  several  cases  collected  by  him 
of  which  the  following  is  typical: 

A  hospital  apprentice  at  Canacao,  Philippine  Islands,  in  June,  1907,  while 
bathing  off  the  hospital  wharf,  was  stung  by  a  jelly-fish.  He  said  that  he  was  some 
distance  from  the  landing,  and,  as  soon  as  he  felt  the  sting,  he  turned  back  to  the 
wharf;  that  on  his  way  he  felt  some  pain  across  his  back,  but  thought  it  was  due  to 
swimming.  On  his  way  up  to  the  hospital  he  began  to  feel  bad  and  sat  down  for 
a  little  while.  When  he  reached  the  hospital,  about  thirty  minutes  after  he  had 
been  stung,  he  became  prostrated  and  had  to  be  carried  to  bed. 

On  arrival  I  found  a  slightly  raised,  vesiculated,  red  area  over  the  left  biceps 
muscle.  This  "wept"  like  eczema.  The  patient  was  throwing  himself  around  the 
bed  and  coughing  almost  incessantly,  expectorating  a  thin  mucus.  He  complained 
of  nausea  but  did  not  vomit.  His  face  was  congested  and  anxious.  He  wept  at 
intervals,  a  stream  of  tears  flowing  down  his  face.  His  nose  was  occluded  as  in  a 
bad  case  of  coryza  and  from  it  a  thin  mucus  was  discharging.  He  complained  of 
pair  in  his  head  and  of  marked  pain  in  the  lumbar  region.  He  expressed  much 
anxiety  as  to  his  condition  and  exclaimed  now  and  then;  "I  don't  know  why,  but 
I've  lost  all  my  nerve."  His  temperature  was  ioo.2°F.;  pulse  100,  strong  and  full. 
Examination  of  blood  and  urine  showed  nothing  abnormal. 

Medical  Director  C.  P.  Kindleberger,  U.  S.  Navy,  reported  a  fatal 
case  resulting  from  sting  on  the  right  forearm  in  case  of  a  Filipino 
boy  about  fourteen  years  of  age. 

mptoms  of  jelly-fish  poisoning  appear  to  be  erythematous  welts, 
.  short  hacking  cough,  rapid  respiration,  thin  mucoid  expectoration, 
marked   coryza,  and  lacrimation   with  rapid  prostration,   congested 
face,  and  great  anxiety  on  the  part  of  the  patient  concerning  the  out- 
come. 

As  the  prostration  comes  on  very  rapidly  the  person  should  get 
out  of  the  water  immediately  after  being  stung  by  a  jelly-fish,  before 
the  depression  becomes  so  great  that  drowning  may  result  from  inability 
to  get  to  a  point  of  safety. 

Tin-  Portuguese  man-of-war,  Physalia  pa'  mses  poisoning 

fever  at  time-.     I.r  Dantec  states  that  the  natives  of  Columbia 

use  Physuliti  as  a  poison.     The  animal  is  dried,  pulverized,  and  used 

for  criminal  purposes  occasionally.     In  Guadeloupe  the  farmers  use 

for  poisoning  rats  and  similar  harmful  animals. 

Certain  of  the  Ztnintharia  or  sea  anemones  cause  urticarial  symptoms 
upon  contact  with  human  skin,  a  do  the  millepore  coral  polyps. 

It  is  probable  that  the  skin  may  be  protected  from  stings  of  jelly- 


316  NAVAL   HYGIENE 

fish  and  coral  polyps  by  anointing  it  with  oil.     This  protects  against  the 
sea  anemone. 

III.  Grand  Trauma.— Sharks  attack  swimmers  probably  less  com- 
monly than  is  generally  supposed.  There  are  several  species  of  sharks. 
Car  char  odon  carcharias,  or  the  "man-eating  shark,"  is  the  only  species 
which  is  believed  to  attack  man.  It  is  the  so-called  "white  shark" 
of  the  tropics  and  grows  to  a  length  of  thirty  or  forty  feet.  In 
tropical  and  sub-tropical  waters  where  sharks  are  very  numerous  the 
opinion  has  been  expressed  to  the  writer  that  they  almost  never  attack 
uninjured  persons,  but  are  very  apt  to  attack  immediately  persons  who 
may  be  injured  and  bleeding. 


FIG.   1 1 8. — Fatal  shark  bite  reported  by  Surgeon  Prioleau,  U.  S.  N. 

The  late  Mr.  A.  B.  Alexander,  Chief  of  Division  of  Statistics,  of  the 
United  States  Fish  Commission,  expressed  a  similar  belief  to  me. 

Surgeon  P.  F.  Prioleau,  U.  S.  Navy,  has  reported  a  fatal  case  of 
shark  bite  as  follows: 

The  U.  S.  S.  Dale  at  the  time  of  the  accident  was  anchored  in  Canacao  Bay, 
P.  I.  About  5  :oo  p.m.,  May  31,  1917,  E.  E.}  water  tender,  attached  to  the  U.  S.  S. 
Dale,  started  out  for  a  long  swim,  accompanied  by  one  of  his  shipmates.  E.  E. 
was  a  most  excellent  swimmer,  and,  after  a  time,  his  companion  becoming  tired  and 
not  wishing  to  go  further  left  him,  and  he  continued  to  swim  alone  in  the  direction  of 
the  open  bay.  About  5  : 45  p.m.  a  seaman  of  the  U.  S.  S.  Monterey  happened  to 
notice  E.  E.,  who  was  then  some  200  yards  from  the  ship,  fall  suddenly  on  his  back 
and  then  give  two  or  three  violent  strokes  in  the  water.  At  the  same  time  the 
observer  saw  a  shark  in  close  proximity  to  the  bather.  It  was  not  hard  to  conjec- 
ture that  some  accident  had  occurred,  and  a  boat  was  rapidly  lowered  and  rushed 


MAR  l.\i:    ANIMAL    LIFE    DANGEROUS    TO    MAN  317 

to  the  vicinity  where  the  man  had  last  been  seen.  The  body  was  recovered,  but  it 
was  evident  from  the  extensiveness  of  the  wound  that  the  man  was  dead.  He  was 
then  taken  to  the  morgue  of  the  United  States  Naval  Hospital,  Canacao,  P.  I. 

<rly  the  entire  abdominal  cavity  had  been  torn  away.  Indeed,  the  wound 
led  from  the  ensiform  cartilage  nearly  to  the  brim  of  the  pelvis.  Laterally, 
from  the  right  mid-axillary  line  to  the  left  mid-axillary  line.  The  stomach,  the  small 
and  large  intestine,  with  the  exception  of  a  few  feet,  most  of  the  liver  and  bladder, 
half  of  the  left  kidney  and  all  of  the  large  abdominal  blood-vessels  were  removed. 
The  illustration  shows  the  wound  as  it  appeared  a  few  hours  after  the  accident.  A 
portion  of  the  ribs  had  been  taken  out  with  the  nicety  of  a  costotome.  Some  of  the 
skin  along  the  edges  of  the  wound  was  in  ribbons  and  bore  the  imprint  of  the  monster's 

Medical  Director  Middleton  S.  Elliot,  U.  S.  Navy,  has  reported 
from  the  U.  S.  S.  Annapolis  in  1901  the  following  case: 

A  gunner's   mate,   third  class,  while  bathing  in  the  harbor  of  Iloilo,  P.  I.,  on 

June  ^4,  was  bitten  by  a  shark,  the  left  leg  being  torn  away  to  the  knee.    The  man  had 

i-hore  with  a  firing  party  at  i  :  oo  p.m.  and  about  two  hours  later  went  in 

s\vin  ming.     While  about  30  feet  from  the  shore,  in  a  depth  of  water  of  10  or  12 

feet,  he  was  heard  to  give  a  cry  and  was  seen  to  disappear  for  a  few  moments;  when 

he  arose  to  the  surface  he  swam  to  the  dingey  10  feet  away  and  was  helped  into  the 

boat      It  was  seen  that  the  left  leg  was  gone.     A  tourniquet,  improvised  of  a  silver 

match  box  and  handkerchief,  was  immediately  applied  by  one  of  the  men  and  the 

dinjjry  Parted  off  to  the  ship,  which  was  distant  about  2  miles.     When  the  boat 

1  the  -hip,  the  medical  officer  being  absent,  Assistant  Surgeon  Jacob  Stepp, 

U.S.  Navy,   was  summoned  from  the  Isla  de  Luzon  and  a  circular  amputation  was 

:ned,  the  lower  third  of  the  femur  being  removed.     Subsequent  surgical  work 

•juired,  but  recovery  resulted. 

The   wound  was  peculiar,  the  thigh  having  been  grasped  about  4  inches  above 
nee  joint,  stripped  down  to  the  bone  and  the  leg  torn  away  at  the  joint,  thus 
extremity  of  the  femur  free  from  all  tissue.     He  stated  that  he  re- 
membered n<>tlim-  <  M  .  ,-pt  that  he  frit  something  suddenly  seize  his  leg  and  draw  him 
i/ed,  lie  evidently  thrust  his  hand  down  in  his  efforts  to  free  himself 
night  his  iinuers  in  the  >hark'>  mouth,  as  on  the  thumb  and  index-finger  of  his 
left  land  -nail  triangular  wound-. 

These  authentic  instances  of  shark  bite  have  occurred  in  the  naval 
e  during  the  past  sixteen  years,  and  are  quoted  in  support  of 
recommendation  that  shark  nets  be  spread  at  stations  where  there  is 
nuu  h  swimming  in  waters  infested  with  sharks. 

Since  sharks  tend  to  avoid  shoal  water  swimmers  may  have  some 
protection  by  staying  in  shallow  water.  The  above-mentioned  fatali- 
ties should  not  deter  the  practice  of  swimming,  since  the  deaths  from 
shark  bite  hi  the  naval  service  during  the  period  above  mentioned  are 


318  NAVAL   HYGIENE 

negligible  when  compared  with  the  number  of  deaths  from  drowning 
during  a  corresponding  period. 

IV.  Postmortem  Decomposition. — The  flesh  of  fish  decomposes 
rapidly,  especially  in  the  tropics,  and  may  become  infected  with  the 
bacillus  of  Gartner  or  with  Bacillus  paratyphosus  B,  (Schotmuller). 
These  organisms  produce  marked  gastro-intestinal  irritation,  choleraic 
in  character,  with  profound  depression  and  sometimes  collapse  and 
death. 

Treatment. — Cases  of  this  character  should  receive  castor  oil, 
followed  by  treatment  for  shock. 

While  on  a  visit  to  Mbau  in  the  Fiji  Islands  I  was  called  upon 
immediately  after  my  arrival  to  treat  a  woman  moribund  with  fish 
poisoning.  She  had  eaten  recently-caught  fish  of  questionable  quality 
about  twenty-four  hours  previously.  She  was  in  profound  collapse 
with  all  the  usual  symptoms  of  fish  poisoning,  and  died  within  forty 
minutes  after  she  was  seen.  Immediately  after  her  death  I  left  the 
house,  but  shortly  was  summoned  to  return.  Upon  my  arrival  at 
the  house  I  was  presented  with  the  woven  grass  mat  upon  which  the 
women  died  as  a  token  of  great  respect  and  appreciation. 

Her  case  is  illustrative  of  what  may  occur  in  connection,  with  fresh 
fish  in  the  tropics.  The  fish  had  been  out  of  water  in  the  tropical 
temperature  a  longer  time  than  was  safe,  had  the  fish  been  wholesome 
otherwise.  There  was  a  doubt,  however,  as  to  the  innocuous  quality 
of  that  kind  of  fish  even  when  fresh. 


CHAPTER  XXIII 
INSECTS  WHICH  MAY  PROVE  DANGEROUS  TO  MAN 

Cockroaches. — The  roaches  belong  to  a  very  large  family,  the 
BlcttidcB.  They  flourish  in  warm  countries.  On  shipboard  commonly 
they  are  very  troublesome.  The  heat  and  moisture  give  favorable 
conditions  for  their  development. 

Two  species  almost  never  occur  in  the  same  house.  They  appear 
to  be  antagonistic  to  each  other.  The  species  infesting  ships  and  houses 
are  dark  brown  or  dark  colored.  The  color  aids  in  their  well-known 


FIG.   119. — The  German  roach  (Blattella  germanica;  stages  a  to  d  show  develop- 
ment up  to  e,  the  adult;  /,  adult  female  with  egg  case;  g,  egg  case  enlarged  about  six 
;  h,  adult  with  wings  spread.     All  natural  size  except  g.     (From  Riley.)     This 
is  the  roach  commonly  found  aboard  ship. 

concealment  during  daylight.  The  males  have  two  pairs  of  wings, 
the  out  IT  being  somewhat  chitinous,  the  other  membranous.  The 
legs  have  bristles  or  spines  and  are  long  and  strong.  The  mouth  parts 
an  powerful,  enabling  the  eating  of  hard  substances,  for  instance, 
leu'lu-r,  woolens,  book  bindings,  etc. 

The  roaches  most  commonly  found  aboard  ship  are  the  German 
cockroaches,  which  are  the  vile-t  of  a  vile  family.  They  thrive  around 
galleys,  pantries,  or  other  places  where  the  temperature  is  warm,  con- 
cealing tin ni-elves  in  the  day  and  coming  out  at  night  to  feed.  Aboard 
ship  they  frequently  destroy  considerable  food  stuff,  and  if  permitted 

319 


32O  NAVAL    HYGIENE 

to  develop  in  numbers,  ruin  foods  to  which  they  have  had  access.  The 
disagreeable  roachy  odor  comes  from  a  dark  fluid  exuded  from  the 
mouth  and  also  from  the  excrement.  The  eggs  are  laid  in  a  hard  cap- 
sule, which  almost  fills  the  body  of  the  female  before  oviposition. 
Each  capsule  contains  many  eggs.  When  the  young  are  hatched 
they  pass  through  several  molts  and  it  is  said  that  four  or  five  years 
are  necessary  for  an  individual  to  reach  its  full  growth. 

Hummel  has  shown  that  the  German  cockroach  may  attain  full 
growth  within  six  months  under  favorable  conditions.  The  German 
cockroach  is  sometimes  called  the  Croton  bug,  because  attention  was 
first  attracted  to  it  in  this  country  as  result  of  extension  of  the  Croton 
system  of  water  works  in  New  York  City.  This  pest  may  be  carried 
long  distances  through  water  pipes  without  injury.  Cockroaches  hide 
and  hibernate  during  winter. 

Remedies.  Poisons.  Sodium  Fluoride. — Of  the  poisons  sodium 
fluoride  is  most  effective.  It  should  be  dusted  into  the  runways  or 
hiding  places  of  the  roaches.  It  cannot  be  depended  upon  if  used  in 
the  presence  of  moisture.  The  surface  must  be  dry. 

Phosphorus. — A  sweetened  flour  paste  containing  2  per  cent,  of 
phosphorus  is  a  very  useful  poison. 

Sulphur. — Mudd  states  that  flowers  of  sulphur  dusted  along  their 
runways  is  a  very  effective  repellent. 

Fumigants. — See  chapter  on  disinfection. 

Aboard  ship  the  jet  from  the  steam  hose  will  often  prove  an  effect- 
ive means  of  exterminating  cockroaches  in  cracks  where  mechanical 
cleaning  appears  impracticable. 

Traps. — As  cockroaches  feed  at  night  an  extremely  efficient  trap 
for  them  may  be  used  by  greasing  with  rancid  butter  the  inner  surfaces 
of  the  sides  of  bread  pans  about  3  inches  in  depth.  The  butter  attracts 
the  insects  by  its  odor  and  once  in  the  pan  they  cannot  crawl  out  over 
the  greased  surface  nor  can  they  fly  out.  Large  numbers  can  be 
trapped  thus  and  killed  by  pouring  boiling  water  into  the  pan. 

As  cockroaches  crawl  almost  everywhere  and  grovel  in  filth,  they 
readily  may  spread  filth-  and  sputum-borne  diseases  by  infecting  food 
and  water. 

Lice. — The  close  contact  of  individuals  on  board  ship  predisposes 
to  ready  transmission  of  lice  from  one  person  to  another.  However, 
the  facilities  for  bathing  and  for  washing  clothes  are  so  good  that  lice 
are  little  seen  among  the  enlisted  men  of  the  Navy. 


INSECTS    WHICH   MAY   PROVE    DANGEROUS    TO    MAN 


321 


Phthirius  pubis  (Pediculus  pubis),  the  crab  louse,  is  oftenest  seen. 
During  twenty-one  years  of  service  the  writer  does  not  remember  to 
have  seen  a  case  of  infestation  of  an  enlisted  man  with  Pediculus 
I'cstimenti  (corporis).  An  occasional  instance  of  infestation  with 
Pediculus  humanus  (capitis)  is  seen. 

Forces  on  shore  having  poor  or  no  facilities  for  bathing  and  washing, 
suffer  much  from  lice,  and  when  they  come  aboard  ship  may  readily 
spread  lice  among  a  naval  crew  serving  on  transport  duty.  Lice  have 


Fi<;.   1 20. — Siphunculata   and   Rhynchota.      I.  Pediculus   capitis.     2.  Pediculus 
vtslimenti.     2a.  Protruded  rostrum  of  Pediculus.     3.  Phthirius  pubis.     4.  Acanthia 
iria.     5.  A.  rotuntiata.     6.  Conorhinus    tnegislus.     (From    Stilt.) 

been  proved  to  transmit  typhus  fever  and  relapsing  fever.  Their  role 
in  transmission  of  other  infectious  diseases  is  not  known.  They  have 
been  found  to  harbor  B.  Icpra  when  living  on  a  leprous  host. 

Pediculus  Vestimenti  (or  Pediculus  Corporis).— The  body  louse  is 
about  3  X  i-5  mm.  in  size.  The  female  lays  from  three  to  eight  eggs 
daily  during  the  entire  period  of  adult  life. 

These  eggs  are  yellowish  brown  in  color,  small,  and  almost  pear- 
shaped.     They  are  covered  by  a  chitinous  shell,  and  firmly  attached 
to  the  underclothing  by  a  cement. 
21 


322  NAVAL   HYGIENE 

The  eggs  hatch  in  ten  days  and  undergo  no  metamorphosis.  They 
attain  sexual  maturity  in  twelve  days. 

Head-gear,  clothing,  shoes,  bedding,  furniture,  carpets  and  hangings 
may  become  infested  by  the  body  louse.  It  lives  on  the  clothing, 
especially  in  the  creases,  except  when  sucking  blood,  which  it  does 
twice  a  day.  It  carries  typhus,  and  may  carry  relapsing  fever.  Riggs 
considered  it  a  carrier  of  enteric  fever.  (See  Trench  Fever.) 

Eradication. — (a)  When  the  clothing  will  not  be  injured  by  steam  it 
should  be  subjected  to  steam  under  pressure  for  twenty  minutes  if 
practicable;  if  not,  boiled  for  one-half  hour. 

(b)  Clothing  which  would  be  injured  by  boiling  should  be  immersed 
in  coal  oil,  gasolene,  petrol  or  benzene.  This  is  the  best  method  for 
treating  woolen  garments  and  blankets.  It  kills  both  lice  and  eggs. 

(c).  Peacock  regards  "N.  C.  I."  as  the  best  agent  for  killing  lice. 
"N.  C.  I."  is  composed  of  naphthalene  96  per  cent.,  creosote  2  per  cent, 
and  iodoform  2  per  cent.  One  ounce  per  man  per  week  should  be 
dusted  inside  the  clothing.  If  this  is  done  at  night  and  the  man 
wraps  up  in  his  blanket  the  lice  are  killed  by  morning. 

(d)  Elbert  and  Soulima  recommend  for  troops  one  of  the  following: 

1.  Thirty-five  per  cent,   cresol  and  65  per  cent,   naphtha  soap. 
This  kills  lice  and  eggs.     The  odor  acts  as  repellent  for  several  weeks. 

2.  Thirty-five  per  cent,  xylol  and  65  per  cent,  naphtha  soap. 

(e)  The  hot  ironing  of  seams  of  garments  once  a  week  kills  adult 
lice  and  also  any  newly  hatched  ones.     If  in  addition   to    ironing 
"vermijelli"  (crude  mineral  oil  9  parts,  soft  soap  5  parts,  and  water 
i  part)  is  smeared  into  the  seams  the  young  will  be  killed  as  hatched. 

Moore  concludes  after  careful  study  that  a  mixture  containing  talc  20  grams, 
creosote  i  c.c.,  sulphur  %  gram  is  six  times  more  effective  than  "N.  C.  I.,"  is  less 
irritating  to  the  skin  and  is  more  readily  applied.  He  regards  unfavorably  the 
impregnation  of  underwear  and  recommends  the  use  of  a  cheese  cloth  pajama 
suit  impregnated  with  the  insecticide  and  worn  outside  the  underclothing. 

He  also  recommends  chlorpicrin  or  nitrochloroform  which  is  volatile,  pene- 
trating and. very  toxic. 

Both  lice  and  eggs  are  killed  in  thirty  minutes  if  clothing  is  placed  in  a  closed 
metal  chamber  (e.g.,  a  galvanized  iron  can)  and  chlorpicrin  sprinkled  through  the 
garments. 

Dry  heat  i4o°C.  kills  lice  and  eggs  in  30  minutes. 
Dry  heat*i6o°C.  kills  lice  and  eggs  in  10  to  15  minutes. 
(/)  Gunn  finds  a  solution  of  sulphur  i  per  cent,  and  naphthalene  i 
per  cent,  in  benzol  most  effective.     Garments  are  immersed  in  this  solu- 


INSECTS   WHICH  MAY   PROVE   DANGEROUS   TO   MAN  323 

tion.  The  benzol  evaporates  and  leaves  the  fabric  impregnated  with 
sulphur  and  naphthalene,  which  prove  prophylactic  and  insecticidal 
against  pediculi  and  against  Acarus  scabei  also.  He  says,  "One  man 
showed  me  a  shirt  with  over  200  dead  lice  on  it  after  using  the 
solution." 

(g)  Turpentine  kills  lice  and  nits. 

A  soap  solution  containing  10  per  cent,  tetrachlorethane  or  2  per 
cent,  trichlorethylene  will  rid  garments  of  lice  in  one-half  hour  if  they 
are  soaked  in  the  solution  at  a  temperature  of  54°F. 

The  phenol  disinfectants  are  unsatisfactory. 

Phthirius  pubis  (Pediculus  pubis)  or  the  "crab"  louse. — This  louse 
is  that  most  commonly  seen  in  the  naval  service.  It  infests  the  pubic 
hair.  In  hirsute  individuals  it  may  spread  upon  abdomen,  chest  and 
other  hairy  parts.  I  have  seen  a  case  in  which  this  occurred,  nits 
bdng  found  in  the  eyebrows. 

The  jug-shaped  female  is  about  J^5  inch  long,  lays  a  dozen  eggs, 
and  in  a  week  the  young  are  hatched.  The  crab  louse  clings  tena- 
ciously to  the  skin  by  means  of  the  powerful  hooks  on  the  second  and 
third  pairs  of  legs,  and  is  removed  with  difficulty  by  the  aid  of  forceps. 

Extermination. — This  is  best  accomplished  by: 

(a)  Treating  the  clothing  by  one  of  the  methods  described  under 
P.  vestimenti. 

(b)  Thorough  washing  of  the  pubic  region  and  perineum  with  soap 
and  water,  after  which  the  hairy  parts  should  be  treated  with  10  per 
cent,  acetic  acid  to  remove  the  nits,  and  blue  ointment  should  be  gener- 
01  ;-]>-  rubbed  into  the  skin  and  hair. 

(c}  Kerosene  may  be  applied  locally.  If  this  is  done  the  clothing 
should  be  left  off  until  the  oil  is  evaporated.  The  writer  has  seen  a 
self-treated  case  blistered  as  result  of  putting  on  the  clothing  too  soon 
after  the  application. 

Turpentine   may   be   used   locally   but  cautiously  to  prevent 
hi  storing. 

(e)  It  may  be  necessary  to  shave  or  clip  short  the  pubic  hair  in 
or  ler  to  remove  the  nits,  which  usually  are  attached  to  the  hair  some 
di>lame  from  the  skin. 

(/")  As  the  nits  hatch  out  in  about  six  days  a  second  insecticidal 
treatment  should  be  employed  one  week  from  the  li: 

Too  commonly  treatment  is  directed  solely  at  the  insects.  The 
clothing  should  be  thoroughly  treated  also.  The  writer  believes  that 


324  NAVAL   HYGIENE 

the  use  of  kerosene  on  water-closet  seats  once  weekly  is  good  practice 
if  the  seats  cannot  be  treated  with  a  steam  hose.  White  enamel 
painted  seats  of  hard  wood  are  recommended. 

Pediculus  Humanus  (P.  Capitis). — The  female  lays  about  fifty  eggs. 
These  hatch  in  a  week,  mature  rapidly  and  deposit  eggs  in  three  weeks. 
"They  vary  in  color  according  to  the  color  of  the  hair  of  the  host." 
(Stitt.) 

Extermination. — This  is  easily  accomplished  in  military  service. 

The  hair  may  be  clipped  or  shaved  from  the  head  to  remove  the 
nits.  Then  turpentine  or  kerosene  may  be  applied  to  the  scalp  care- 
fully. In  cases  where  the  hair  may  not  be  cut  short  the  application  of 
10  per  cent,  acetic  add  will  loosen  the  nits,  which  may  be  removed  by 
use  of  a  fine-toothed  comb. 

The  head-gear  should  not  be  forgotten,  but  should  be  carefully 
treated  with  gasolene,  kerosene,  or  turpentine. 

The  Bed  Bug. — The  bed  bug  (Acanthia  lectularia)  may  gain  en- 
trance to  a  ship  or  barracks  in  the  baggage  of  the  men,  in  baskets 
of  laundry,  or  upon  the  clothing  of  those  returning  from  liberty  spent 
in  houses  infested  with  these  "crimson  ramblers."  I  saw  bed  bugs 
upon  captured  accoutrements  which  were  brought  aboard  the  U.  S.  S. 
North  Dakota  by  our  men  who  took  over  the  fortress  at  Vera  Cruz  in 
1914.  The  bed  bug  belongs  to  the  Hemiptera,  has  a  piercing  and 
sucking  beak,  and  has  rudimentary  wings  or  pads.  The  adult  is  flat- 
tened, oval  and  mahogany  red  in  color,  the  abdomen  being  tinged 
with  black.  After  feeding  the  body  assumes  a  bright  color  from  the 
blood  which  it  has  taken,  is  elongated  and  distended.  The  absence 
of  wings  in  the  bed  bug  is  a  blessing  to  man.  The  bed  bug  possesses  a 
characteristic  odor  which  comes  from  glands  in  several  parts  of  the  body. 

The  bed  bug  normally  feeds  at  night  but  hunger  may  drive  it  to 
attack  voraciously  in  the  daytime.  After  feeding  it  leaves  the  body 
and  conceals  itself  in  its  normal  hiding  place,  which  commonly  is  a 
crack  in  the  wall  or  under  loose  wall  paper  or  about  the  bedstead  or  in 
the  seams  and  tufting  of  the  mattress.  Their  powers  of  concealment 
are  remarkable.  It  is  said  they  can  go  into  any  crack  which  will 
admit  the  edge  of  a  sheet  of  writing  paper. 

The  eggs  are  deposited  several  times  a  year  in  batches  of  about  fifty. 
Under  favorable  conditions  they  hatch  in  ten  days  and  the  yellowish 
white  insects  emerge.  They  pass  through  five  molts  before  reaching 
the  adult  stage. 


INSECTS    WHICH   MAY  PROVE   DANGEROUS   TO   MAN  325 

The  bed  bug  takes  one  meal  between  each  molt,  requiring  about 
five  to  ten  minutes  of  feeding  before  becoming  filled  with  blood.  Mar- 
latt  states  that  "Young  bed  bugs  obtained  from  eggs  were  kept  in  small 
sealed  vials  for  several  months,  remaining  active  in  spite  of  the  fact 
that  they  had  never  taken  any  nourishment  whatever."  The  insect 
probably  can  survive  for  a  year  without  food. 

In  residences  where  the  bed  bug  feeds  constantly  on  the  same 
•ns  the  danger  of  transmission  of  disease  is  comparatively  small, 
but  on  board  ship,  in  barracks,  on  trains,  and  in  hotels  the  proba- 
bility of  disease  transmission  is  considerably  increased. 

Kala-azar,  plague,  relapsing  rever,  and  chagas  fever  have  been 
transmitted  by  the  bed  bug.  Typhus,  leprosy,  syphilis,  and  other 
di  -eases,  possibly  are  transmitted  by  it. 

Remedies.  —  Fumigation  with  sulphur  is  best  on  board  ship.  It 
kills  both  the  insects  and  eggs.  Hydrocyanic  gas  is  unsafe.  Insect 
p<  >\vders  are  of  slight  value.  Benzene  and  kerosene  injected  into  cracks 
are  effective.  Corrosive  sublimate  is  of  value.  The  writer  has  used 
the  gasolene  torch  on  board  ship  with  good  effect,  and  where  practicable 
the  steam  hose  is  useful. 

Flies.  —  Flies,  especially  the  common  house  fly,  Musca  domestic*, 
often  come  aboard  ships  on  the  clothing  of  persons  coming  aboard,  or 
on  marketing  and  fresh  provisions.  When  the  ship  lies  alongside  the 
<1(  c  k  or  is  in  the  dry  dock,  they  may  become  a  pest,  owing  to  their 

it  numbers. 

The  house  fly  may  be  considered  as  a  type. 

The  eggs  are  laid  in  manure  of  various  kinds,  and  almost  any  rotting 
tiic  matter. 

In  a  Kroup  of  -torerooms  on  the  U.  S.  S.  North  Dakota  the  writer  saw  many 

fli<  s  I.ir-r  an«l  small,  which  indicated  breeding  m-ar  by.     Careful  search  discovered 
"f  mustard,  UK-  top  of  which  had  been  broken  and  the  surface  of  the  decom- 
•ij;  mustard  literally  was  covered  with  larva-  and  pupae. 


fre-h  vegetal  >le  lockers  are  a  common  breeding  place  of  flies 
aboard  ship.  They  breed  in  decomposing  vegetables,  especially  onions, 
and  unless  the  source  of  supply  of  flies  is  recognized  the  ship  rapidly 
may  become  infested  with  them. 

The  female  fly  lays  1  20  eggs  at  a  time,  several  females  ovipositing 
in  the  same  spot,  so  that  the  eggs  are  in  groups  or  clusters  in  crevices 
in  the  manure  or  other  material.  The  maggots  hatch  within  twenty- 


326 


NAVAL   HYGIENE 


four  hours,  attain  full  size  within  four  days,  and  enter  the  pupal  stage. 
In  this  resting  stage,  which  lasts  from  three  to  ten  days,  the  maggot 
contracts  within  its  old  skin  which  forms  a  round  case  having  rounded 
ends,  somewhat  resembling  the  egg  pod  of  the  cockroach,  but  not  so 
flat.  The  transition  from  egg  to  adult  fly  requires  from  eight  to  fifteen 
days. 

When  the  ship  is  away  from  the  dock  all  flies  should  be  killed  as 
soon  as  possible,  and  in  localities  where  there  are  many  flies  they  should 
be  driven  off  the  market  boats  as  the  boats  approach  the  ship. 


FIG.  121. — Common  housefly  (Musca  domestica):  Puparium  at  left;  adult  next, 
larva  and  enlarged  parts  at  right.  All  enlarged.  From  circular  71  (by  L.  O.  How- 
ard), Buerau  of  Entomology,  U.  S.  Department  of  Agriculture.  (From  Stilt's 
Bacteriology.} 

The  vegetable  crates  and  lockers  should  be  covered  with  tarpaulin 
to  prevent  access  of  flies.  During  warm  weather  the  vegetables  should 
be  culled  weekly  to  prevent  fly  breeding  as  well  as  to  remove  rotting 
vegetables. 

Animal  pets  should  not  be  allowed  on  board  as  they  attract  flies. 

Decomposing  animal  and  vegetable  matter  should  not  be  allowed 
on  board  ship. 

A  plague  of  flies  invaded  the  U.  S.  S.  North  Dakota  in  June,  1915, 
in  the  Philadelphia  Navy  Yard.  Through  the  ventilating  system  many 
were  introduced  into  the  storerooms  and  passages  and  appeared  to 
have  starved  there,  famished  through  lack  of  water,  or  were  killed  in 
passing  through  the  ventilating  system.  Dust  pans  full  of  dead  flies 
were  swept  up.  Many  living  flies  were  found,  showing  that  the  insects 
may  survive  passage  through  the  ventilating  blowers  and  ducts. 


INSECTS    WHICH   MAY   PROVE   DANGEROUS    TO    MAN  327 

At  this  time  it  was  noticed  cockroaches  disappeared,  as  if  there 
mi^ht  be  antagonism  between  flies  and  roaches. 

Remedies. — On  board  ship  all  garbage  should  be  thrown  overboard 
or  incinerated.  If  the  ship  is  not  alongside  the  dock  flies  may  be 
quickly  expelled  from  many  compartments,  for  instance  the  galley, 
by  permitting  the  escape  of  free  steam,  before  a  cloud  of  which  they  fly 
desperately  in  effort  to  escape. 

Various  forms  of  fly  traps  have  been  used,  having  as  bait  some 
mixture  containing  sugar,  molasses,  or  milk.  These  have  proved  very 
effective  in  catching  flies,  which  may  then  be  killed  by  submerging 
the  trap  in  hot  water. 

Poison  baits  may  be  used.  A  half  dram  of  formalin  in  an  ounce  of 
sweetened  water  or  milk  is  very  effective.  The  solution  should  be  in 
shallow  dishes  in  which  a  crust  of  bread  is  placed.  Flies  may  alight 
upon  it  to  feed.  All  organic  refuse  should  be  destroyed.  This  step, 
wi  h  the  killing  of  flies  and  the  aid  of  the  wind  blowing  through  the 
ship,  will  soon  rid  her  of  the  insects. 

The  writer  has  seen  minor  offenses  punished  at  the  mast  by  assigning 
to  the  offender  "extra  duty"  consisting  of  delivery  of  a  number  of 
dead  flies  or  roaches.  This  punishment  gave  the  offender  work  to  do 
which  was  in  the  interest  of  the  health  of  the  ship. 

Water  closets,  galley  and  butcher  shops  should  be  screened  against 
Hit-  aboard  ship. 

In  camps  food  should  be  protected  from  the  flies.  Kitchen  refuse 
should  be  promptly  burned,  the  fluid  refuse  being  received  into  soakage 
pits  where  it  is  impracticable  to  evaporate  it  during  the  incineration 
of  solid  refuse. 

Latrines  should  be  fly-proof.  The  tops  should  be  carefully  examined 
each  morning  to  insure  that  they  are  tight. 

Lelean  states  that  the  latrine  trenches  should  be  lined  with  "sacking  soaked  in 
oil  and  wretched  <>n  wooden  frames"  to  prevent  the  escape  of  fly  larvae  which 
1  through  ordinary  sand  a  distance  of  5  or  6  feet.     Near  the  surface  of  the 
ground  they  enter  the  pupal  stage  and  hatch  out  young  flies.     Where  it  is  impracti- 
cable  to   line   the   trench    with   sacking,    an   area  3  feet  wide  entirely  around  the 
treiK  h  should  he  covered  with  sacking,  hoards,  or  heavy  tarred  paper  to  prevent  the 
escape  upward  01"  th<  Tin-  outer  n  imhes  of  the  material  used  should  be 

turned  downward  vertically.     Tin-  newly  hatched  llics  die  under  this  surface  being 
pe.      Filled  latrines  should  be  covered  in  the  same  v, 

To  prevent  fly  breeding  in  manure,  borax  o.(>2  pound  and  crude 
calcium  borate  0.75  in  3  gallons  of  water  was  found  effective  for  each 


328  NAVAL   HYGIENE 

10  cubic  feet  of  manure.  This  destroys  all  maggots  and  does  not 
inhibit  the  growth  of  plants.  The  cost  of  this  treatment  of  manure 
is  about  one  cent  per  horse  per  day. 

Manure  may  be  spread,  dried,  and  burned. 

The  close  packing  method  is  one  in  which  the  manure  is  dumped 
on  hard  ground  and  beaten  down  with  shovels.  The  pile  should  not 
exceed  5  feet  high.  As  this  beating  tends  to  form  an  air-tight  surface 
over  the  manure  pile  the  temperature  resulting  from  decomposition 
within  the  piles  may  rise  to  i5o°F.,  and  since  fly  larvae  are  killed  at  a 
temperature  of  ii5°F.  this  method  is  quite  effective. 

A  i  per  cent,  solution  sodium  arsenite,  to  which  25  per  cent  of 
sugar  has  been  added,  forms  an  excellent  fly  poison  but  is  very  danger- 
ous. This  should  be  placed  in  shallow  dishes  and  should  be  colored  to 
prevent  mistaking  it  for  other  solutions.  Extreme  care  must  be  taken 
to  prevent  its  getting  into  food  or  drink. 

House  flies  readily  may  be  transmitters  of  bacterial  diseases  as 
has  been  shown  by  the  work  of  Shakespeare,  Vaughan  and  Reed,  during 
the  Spanish- American  War.  After  an  exhaustive  study  of  the  spread 
of  typhoid  fever  in  the  training  camps  they  came  to  the  following 
conclusion: 

We  are  satisfied  that  the  evidence  furnished  in  our  studies,  to  be  detailed  later,  is 
sufficient  to  show  beyond  reasonable  doubt  that  the  most  active  agents  in  the  spread 
of  typhoid  fever  in  many  of  the  encampments  in  1898  were  flies.  The  reasons  for 
coming  to  this  conclusion  will  be  given  in  detail  later,  but  may  be  summed  up  here  as 
follows: 

1.  The  latrines  contained  fecal  matter  specifically  infected  with  typhoid  bacillus. 

2.  Flies  alternately  visited  and  fed  upon  this  infected  fecal  matter  and  the  food 
in  the  mess  tents.     More  than  once  it  happened,  when  lime  had  been  scattered  over 
the  fecal  matter  in  the  pits,  that  flies  with  their  feet  covered  with  lime  were  seen 
walking  over  the  food. 

3.  Typhoid  fever  was  much  less  frequent  among  members  of  messes  who  had  their 
tents  screened  than  it  was  among  those  who  took  no  such  precaution. 

4.  Typhoid  fever  gradually  died  out  in  the  fall  of  1898  in  the  encampments  at 
Knoxville  and  Meade  with  the  disappearance  of  the  fly,  and  this  occurred  at  a  time 
of  the  year  when  in  civil  practice  typhoid  fever  is  generally  on  the  increase. 

Stomoxys  calcitrans  or  the  common  stable  fly  bites  viciously.  The 
writer  has  seen  abscess  and  cellulitis  following  infection  resulting  from 
the  bite  of  this  fly.  It  was  held  by  some  to  be  the  transmitter  of  polio- 
myelitis. This  view  has  not  been  confirmed.  The  measures  rec- 
ommended against  Musca  domestica  are  effective  against  the  stable 
fly. 


CHAPTER  XXIV 
THE  HOSPITAL  SHIP 

The  presence  of  the  hospital  ship  with  the  naval  forces  in  time  of 
peace  as  well  as  in  time  of  war  has  been  abundantly  justified  by  the 
splendid  work  which  has  been  accomplished. 

As  the  hospital  ship  is  analogous  to  the  hospital  on  shore  it  is 
commanded  by  a  naval  medical  officer  not  below  the  grade  of  surgeon. 


PIG.  122. — U.  S.  S.  Solace,  a  hospital  ship.  Note  that  hospital  ships  are  painted 
wh.te,  have  a  green  band  one  meter  wide  all  the  way  around  the  hull,  fly  the  Geneva 
Cross  flag,  and  carry  a  large  red  cross  on  the  smoke  pipe.  At  night  this  red  cross 
is  illuminated  and  the  ship  carries  a  display  of  colored  lights  agreed  upon  by  the 
civ  lized  nations  of  the  world.  An  enemy  firing  upon  these  unmistakable  markings 
does  so  wilfully.  (Photograph  by  Pharmacist  Seckdman,  U.  S.  N.) 

In  times  of  peace  the  naval  hospital  ship  has  a  personnel  of  com- 
mi^ioned  and  enlisted  forces  of  the  navy  which  is  concerned  with  the 
care  and  treatment  of  the  sick,  and  also  a  naval  auxiliary  crew  with 
master  and  officers  who  are  concerned  with  the  navigation  of  the  ship 
and  her  material  upkeep.  The  master,  under  the  medical  officer  in 
command,  has  complete  control  of  the  naval  auxiliary  forces  on  board 
ship,  subject  to  the  regulations  covering  Naval  Auxiliary  Forces  of  the 
United  States  Navy. 

The  naval  auxiliary  force  consists  (a)  of  a  deck  force,  and  (b)  the 

329 


330 


NAVAL   HYGIENE 


engineer's  force.  The  strength  of  the  auxiliary  force  varies  depending 
upon  the  needs  of  the  individual  ship,  but  in  general  terms  consists 
of  a  master,  sufficient  watch  officers,  chief  engineer,  his  assistants, 
deck  and  engine-room  forces.  In  time  of  war  the  hospital  ship  should 
be  manned  by  a  U.  S.  naval  crew. 

The  construction  of  a  hospital  ship  is  limited  by  restrictions  which 
are  not  to  be  considered  on  shore.  In  the  hospital  on  shore  extension 
by  pavilions  or  additions  readily  may  be  made.  On  board  ship  the 
entire  establishment  must  be  constructed  so  as  to  fit  within  the  narrow 


FIG.  123. — The  bridge  of  the  Solace.  Note  the  awnings  and  wind  screens 
for  the  protection  of  those  standing  watch.  (Courtesy  of  Pharmacist  Seckelman, 
U.  S.  AT.) 

confines  of  the  ship's  hull,  and  conditions  which  would  not  be  permit- 
ted in  a  hospital  on  shore  must  be  tolerated  on  board  a  hospital  ship. 
For  instance:  If  a  hospital  ship  is  500  feet  long  its  infectious  ward 
must  lie  within  500  feet  of  crew  quarters,  operating  room,  and  medical 
and  surgical  wards. 

The  hospital  ship  should  be  so  constructed  that  the  wards  and 
operating  room  may  be  well  above  the  water-line  to  enable  access  of 
daylight,  of  fresh  air,  and  to  facilitate  the  handling  of  sick  or  injured. 
The  decks  and  all  gangways  or  passages  should  be  wide  to  enable  the 
handling  and  turning  of  stretchers.  Air-ports  and  ventilating  intakes 


THE    HOSPITAL   SHIP 


331 


should  be  freely  supplied.  The  ship  should  possess  sufficient  speed  to 
enable  her  to  keep  up  with  any  fleet  and  should  have  a  distilling  plant 
capable  of  giving  at  least  300  gallons  of  water  per  day  per  patient, 
plus  an  additional  allowance  of  50  gallons  per  capita  per  day  for  the 


J  H  HA«PHCfO<Ml 


]•!(;.   124. — Double-deck  stationary  bunks  made  of  galvanized  iron  pipe.     The 
springs  should  grip  the  pipe,  not  hook  into  perforations  in  the  pipe.      Bed  bugs 
•he  perforations  and  breed  rapidly  in  this  safe  retreat.     Sulphur  fumigation  is 
required  to  kill  them. 

members  of  the  hospital  corps  and  crew.  This  allowance  should  be 
in  excess  of  requirements  for  feed  water.  The  allowance  of  fresh  water 
should  he  unlimited. 

The  hospital  ship  should  be  equipped  with  medical  and  surgical 
wards  whose  passages  should  be  sufficiently  wide  to  permit  easy  access 


332  NAVAL   HYGIENE 

of  stretcher  and  ward  carriage.  A  space  of  800  cubic  feet  per  person 
should  be  allowed,  and  any  deviation  from  this  standard  should  be 
in  the  nature  of  increase.  The  deck  should  be  covered  with  battle- 
ship linoleum  and  should  be  kept  waxed  to  make  it  further  non- 
absorbent. 

The  bunks  or  beds  should  be  double  banked,  i.e.,  one  above  another 
as  shown  in  the  accompanying  cut.  Their  frames  should  be  made  of 
galvanized  iron  pipe.  The  pipes  constituting  these  frames  should 
be  closed  entirely.  Mattresses  should  be  secured  to  the  frames  by 
gripping  around  the  pipe  at  each  end  of  the  bunk.  The  ends  of  the 
bunk  frame  should  not  be  perforated  in  order  to  enable  the  securing 
of  the  bed  springs  by  hooks.  The  writer  has  seen  the  frames  of  bunks 
of  this  character  become  breeding  places  for  bed  bugs  in  great  number, 
and  access  to  them  was  rendered  extremely  difficult. 

The  hospital  ship  should  be  provided  with  a  dark  room  in  which 
eye,  ear,  nose  and  throat  work  may  be  done,  and  this  department 
should  be  equipped  with  up-to-date  apparatus. 

The  surgical  operating  room  should  have  tiled  deck  and  the  operat- 
ing table  secured  to  the  deck.  Appropriate  instrument  tables  should 
likewise  be  provided  and  secured  to  the  deck. 

The  wash  room  should  be  immediately  attached  to  the  operating 
room  and  should  have  every  facility  for  preparation  for  aseptic  surgery. 
The  sterilizing  room  should  be  separate  from  the  operating  room 
in  order  to  limit  the  amount  of  wild  heat  which  would  be  thrown  off 
during  the  process  of  sterilizing  surgical  dressings,  instruments, 
gowns,  etc. 

The  operating  room  should  be  located  near  the  middle  of  the  ship 
in  order  that  the  motion  may  be  felt  as  little  as  possible.  The  operat- 
ing room  should  be  on  the  same  deck  with  the  surgical  ward,  and  be- 
tween it  and  the  surgical  ward  should  be  interposed  an  anesthetizing 
room  on  the  one  side  and  a  recovery  room  on  the  other. 

A  well-equipped  pathological  and  bacteriological  laboratory  should 
be  installed,  capable  of  doing  work  of  first  order.  Facilities  should  be 
provided  on  deck  aft  where  guinea  pigs,  rabbits,  mice  and  sheep  may 
be  carried  for  diagnostic  and  serological  work. 

A  mortuary  room  should  be  provided  where  remains  may  be  autop- 
sied  and  prepared  for  shipment. 

An  infectious  ward  should  be  provided  for  the  treatment  of  the 
various  infectious  diseases,  with  bath  and  water-closet  facilities  attached 


THE   HOSPITAL   SHIP  333 


to  each  unit  in  the  ward,  thus  enabling  the  isolation  and  segregation 
of  patients  suffering  with  the  several  infectious  diseases. 

The  venereal  ward  should  be  located  so  that  in  case  of  emergency 
it  may  be  converted  into  additional  wards  for  the  care  of  infectious 
d leases.  The  venereal  ward  should  be  supplied  with  dressing  room 
and  room  for  treatments. 

The  psychopathic  ward  should  be  located  near  the  infectious  and 
venereal  wards  so  that  when  not  occupied  by  psychopathic  cases  it  may 
be  available  in  emergency  for  the  treatment  of  infectious  diseases. 


FK..    u.v  -A    \vard   in   a   hospital   ship.     (Courtesy  of  Pharmacist    Seckelman, 

U.  S.  N.) 

The  X-ray  room  should  be  placed  as  close  to  the  surgical  ward  as 
conditions  will  permit  and  should  be  capable  of  doing  work  of  the  first 
order,  since  the  hospital  ship  often  may  act  as  the  analogue  of 
the  ho-pital  on  shore  in  a  city  having  a  population  ranging  into  the 
thousand-. 

An  ice  machine  for  the  manufacture  of  ice  and  for  refrigeration 
of  cold  storage  rooms  is  a  necessity.  The  refrigerating  room  will 


334  NAVAL   HYGIENE 

enable  the  carrying  of  fresh  meats  and  foods,  and  the  refrigerating 
plant  likewise  can  be  utilized  for  the  cooling  of  fresh  water  for  the 
various  drinking  terminals  in  the  wards  and  different  parts  of  the 
ship. 

The  refrigerating  plant  should  include  facilities  for  the  preservation 
of  vaccines  and  sera,  and  a  cold  chamber  should  be  arranged  in  connec- 
tion with  the  postmortem  room  in  which  bodies  may  be  preserved 
in  cold  storage. 

The  ice  machine  should  be  of  the  dense  air  type. 

The  laundry  should  be  equipped  with  tumbler,  extractor,  and  dry- 
ing tumbler  for  the  laundering  of  the  hospital  linen.  In  conjunction 
with  the  laundry  a  disinfecting  plant  should  be  established.  The 
linen  to  be  disinfected  should  be  placed  in  the  autoclave  in  a  room 
outside  the  laundry.  It  should  be  sterilized  and  withdrawn  from 
the  autoclave  into  the  laundry  to  be  washed. 

Sufficient  number  of  baths  and  water  closets  should  be  provided. 

The  hospital  ship  should  have  an  abundance  of  storerooms  in  which 
may  be  kept  drugs,  surgical  dressings  and  appliances,  at  least  one  field 
hospital  for  landing  forces,  and  all  apparatus  necessary  for  the  care 
and  treatment  of  sick  and  wounded  human  beings.  A  supply  of  coffins 
should  be  carried. 

A  well-equipped  dispensary  should  be  provided. 

Galleys,  pantries  and  storerooms  must  be  provided.  The  galleys 
should  be  on  a  deck  above  the  water  so  that  the  odors  from  it  may  not 
pervade  adjacent  compartments. 

Lounging  or  smoking  rooms  should  be  provided  where  convalescent 
officers  and  enlisted  men  may  spend  time  out  of  the  wards  in  bad 
weather. 

Berthing  spaces  for  the  ship's  complement  must  be  provided  as 
well  as  storerooms  for  the  equipment,  repair,  and  preservation  of  the 
ship. 

The  hospital  ship  should  be  steady  and  supplied  with  bilge  keels 
to  prevent  excessive  rolling  and  should  be  fast,  should  be  provided  with 
a  wireless  and  other  signal  apparatus,  and  should  be  electrically  lighted. 
She  should  have  wide  doors  and  ports  so  that  stretchers  may  be  carried 
without  difficulty.  She  should  be  steam  heated  with  high  pressure 
steam  heating  system  and  separate  ventilating  system  until  such  time 
as  the  thermo-ventilating  system  supplying  properly  conditioned  air 
has  been  perfected. 


THE   HOSPITAL   SHIP 


335 


The  hospital  ship  should  be  supplied  with  a  number  of  large, 
swift  motor  boats  for  ambulance  purposes.  Life  boats  should  be 
provided  for  the  total  complement.  A  number  of  cranes  should  be 
vided  for  the  hoisting  of  sick  on  board,  and  large,  wide  ports  should 
provided  in  sufficient  number  to  enable  the  loading  and  unloading 
several  boats  on  each  side  of  the  ship  simultaneously.  Life  pre- 
ers  should  be  provided  for  complement  and  crew,  and  should  be 
stantly  accessible. 


Fu..   126. — Convalescent   patients  brought  on  deck  in  Stokes  stretchers  on  a 
hospital     ship.      (Cnurtt^y  of  Pharmacist  Seckelman,  U.  S.  N.) 

The  ship's  steaming  radius  should  equal  that  of  any  of  the  ships  of 
tin1  tleet.  The  hospital  ship  should  be  an  oil  burner  in  order  that  dust 
may  he  minimized.  HIT  capacity  should  be  about  five  hundred 
patients,  and  all  ward-  >hould  extend  entirely  across  the  ship,  enabling 
complete  perllation  of  each  ward.  Longitudinal  bulkheads  should 
not  interfere  with  this  feature. 

When,  a  hospital  ship  reaches  port  and  desires  to  discharge  her  sick 
in;<>  a  hospital  on  shore,  bed  patients  should  be  sent  first,  so  they  may- 
be assigned  to  beds  in  the  wards. 


336 


NAVAL  HYGIENE 


Ambulant  patients  then  should  be  sent  as  these  may  be  shifted  to 
meet  conditions  if  the  wards  are  congested. 

If  possible  the  hospital  should  be  given  a  day's  notice  of  the 
number  and  character  of  the  patients  it  is  expected  to  receive,  and  the 
probable  hour  of  their  readiness  for  transfer. 

They  should  be  accompanied  by  an  alphabetical  list  of  patients  in 
triplicate  and  by  the  hospital  ticket,  health  record,  service  record,  and 
transfer  of  pay  accounts  in  each  case  as  provided  by  U.  S.  Navy 
regulations. 


CHAPTER  XXV 
ON  THE  MARCH 

In  starting  on  expeditionary  service,  either  from  ship  or  a  base, 
medical  officer  should  see  that  the  following  classes  of  men  are 
uded  from  those  who  are  to  undergo  the  arduous  work  incident 
on  campaign: 

(a)  The  too  young; 

(b)  The  too  old; 

(c)  The  too  fat; 

(d)  All  suffering  with  disease  of  infectious  character; 

(e)  Those  having  deformed  feet,  or  conditions  which  would  interfere 
wrh  marching; 

(/)  Those  convalescent  from  disease  or  suffering  any  constitutional 
disorders;  and 

(g)  Alcohol  and  drug  addicts. 

(a)  The  Too  Young  (Under  twenty  years  of  age). — -This  class  being 
immature  is  not  apt  to  bear  well  the  strain  of  the  work  entailed  in 
marching  and  carrying  a  heavy  pack.     They  have  lessened  resistance 
to  infectious  disease,  are  apt  to  be  rash,  to  display  poor  judgment,  and 
an    less  amenable  to  the  discipline  so  necessary  to  successful  mainte- 
nance of  health  in  campaigning. 

(b)  The  Too  Old. — The  men  past  forty-five  years  of  age  have  not 
tin  recuperative  power  and  the  elasticity  of  tissue  which  go  to  make 
up  tlu-  most  effective  human  machine.     Also  they  tend  to  bear  the 
hardship  and  exposure  less  easily  than  they  would  have  done  twenty 
years  earlier.     They  tend  toward  depression  and  to  lack  the  buoyancy 
so  necessary  to  effective  work  in  any  undertaking. 

(c)  The   Too  Fat.     The   fat   man   is  greatly   handicapped.     The 
transport  of  his  bulk    requires   expenditure   of   more   energy   than  is 
neiessary  for  the  more  efficient  lean  individual  having  an  equal  mass 
of  muscle.     The  fat  individual  is  less  able  to  perform  arduous  work,  as 
his  muscles  tend  to  have  fatty  degeneration,  and  on  long  march  myo- 
cardial  changes  may  become  manifest  and  incapacity  result. 

22  337 


33 8  NAVAL   HYGIENE 

(d)  All  Suffering  from  Disease  of  Infectious  Character.— Those 

suffering  with  disease  of  infectious  character  should  be  excluded,  espe- 
cially those  having  venereal  diseases.  It  should  be  remembered  that 
each  man  who  must  fall  out  of  the  marching  column  incapacitates  not 
alone  his  own  rifle  but  those  of  the  persons  who  must  carry  and  care  for 
him.  Those  who  have  been  exposed  to  infectious  disease  should  be 
left  behind.  If  this  is  impossible  they  should  be  watched  closely. 

(e)  Those  Having  Deformed  Feet,  or  Conditions  Which  Would 
Interfere  with  Marching. — For  obvious  reasons  those  having  flat  foot, 
hammer  toe,  or  any  other  condition  which  would  interfere  with  steady 
marching,  should  be  left  behind. 

(f)  Those  Convalescent  from  Disease  or  Suffering  Any  Constitu- 
tional Disorders. — Convalescents  and  those  suffering  from  constitu- 
tional disease  or  nutritional  disorders  are  not  apt  to  become  inured 
to  campaign  conditions,  but  rather  tend  to  fight  a  losing  battle  when 
they  undertake  to  meet  conditions  which  tax  the  strongest  man. 

(g)  Alcohol  and  Drug  Addicts. — Alcohol  and  drug  addicts  should 
be  left  behind.     They  are  physically  unfit  and  are  unreliable. 

Usually  the  naval  forces  operate  from  the  ships  as  a  base  and  it  is 
seldom  contemplated  that  they  work  far  beyond  the  range  of  the  ship's 
guns. 

When  naval  forces  operate  ashore  they  are  usually  landed  as  in- 
fantry, and  as  such  the  formation  and  regulations  governing  infantry 
apply  to  them. 

Breaking  Camp.— The  fires  upon  the  camp  site  about  to  be  left 
should  be  carefully  extinguished,  latrines,  kitchen  and  sullage  pits 
filled  and  marked,  and  the  site  carefully  policed,  for  this  same  site 
soon  may  be  occupied  by  reinforcements,  or  those  leaving  the  camp  site 
may  return  to  the  same  site  for  camp,  either  in  retreat  or  in 
returning  to  the  base. 

Beginning  the  March. — The  march  should  be  begun  as  early  as 
daylight  will  allow  and  after  an  easily  assimilable  breakfast  has  been 
eaten.  In  the  tropics  and  in  summer  the  march  should  be  stopped  at 
10  :  oo  a.m.  and  resumed  at  4  :  oo  p.m.,  unless  it  can  be  completed  in  the 
morning  by  marching  for  a  brief  additional  period  of  time.  In  tem- 
perate climates,  especially  in  winter,  the  day's  march  should  be  con- 
tinuous and  concluded  before  prolonged  stop  is  ordered. 

Heat  Production. — When  marching  a  gradual  development  of 
temperature  occurs  up  to  about  100.5°  or  even  to  i°20F.  Like  other 


ON    THE    MARCH  339 


machines,  the  human  being  performs  work  better  after  warming  up. 
A  temperature  of  100.5°!''.  is  considered  that  at  which  the  maximum  of 
efficiency  is  obtained,  although  it  is  not  uncommon  to  find  men  who 

te  a  temperature  of  io2°F.  after  finishing  a  day's  march. 
Distance  to  be  Covered. — Two  and  a  half  miles  per  hour  is  a  good 
rage  rate  of  progress  for  troops  in  " heavy  marching  order." 
/iously  this  rate  will  vary  with  terrain,  condition  of  roads,  weather, 
to  be  carried,  temperature,  and  physical  condition  of  the  troops, 
ially  of  their  feet. 

A   well-seasoned  infantry  company  marching  under  good  condi- 
ns  will  cover  12   to   15  miles  daily  and  maintain  this  rate.     For 
ief  time  long  distances  may  be  covered,  but  these  spurts,  which 
may  be  so  great  as  25  miles  in  a  day,  usually  cannot  be  maintained. 
Large  bodies  of  troops  move  more  slowly  than  the  smaller  bodies,  and 
far  more  discomfort  is  felt  from  heat,  humidity  and  dust  in  the  larger 
ies  of  troops  than  in  the  smaller. 

Where  it  is  possible  the  men  should  be  transported  on  cars  or 
ucks  in  order  that  the  troops  may  arrive  in  position  in  as  fresh  a 
ate  as  possible. 

Marching  at  Night. — Marching  at  night  is  to  be  deprecated  and 
lould  be  permitted  only  in  extraordinary  circumstances.  In  the 
dark  men  cannot  be  sure  of  their  footing  and  accidents  are  liable  to 
happen.  Tired  and  sleepy  men  cannot  be  expected  to  give  the  best 
account  of  themselves.  Early  to  bed  and  early  to  rise  should  be  the 
policy  followed. 

Underway. — The  march  should  be  begun  slowly  and  a  halt  of  fifteen 
minutes  should  be  allowed  at  the  end  of  the  first  hour,  and  thereafter 
a  halt  of  ten  minutes  should  be  made  at  the  end  of  each  hour.  During 
these  halts  the  men  should  unloosen  their  packs,  arrange  their  accoutre- 
ments, change  socks  if  necessary,  and  answer  the  calls  of  nature. 

Company  officers  should  be  vigilant  and  assure  themselves  that 
the  non-commissioned  officer  to  whom  the  duty  has  been  delegated  is 
st -icily  enforcing  orders  concerning  disposal  of  dejecta,  all  of  which 
should  be  deposited  in  a  hole  dug  with  an  entrenching  tool  and  imme- 
diately covered  before  the  march  is  resumed. 

In  wet  weather  it  is  recommended  that  troops  form  circles  and  sit 
up»on  one  another's  knees  (Ford).  This  procedure  has  the  advantage 
of  keeping  the  bodies  of  the  men  from  sitting  on  wet  or  muddy 
ground  and  the  further  advantage  of  conservation  of  body  heat. 


340  NAVAL  HYGIENE 

Music  and  singing  should  be  encouraged  unless  there  are  good 
reasons  to  the  contrary. 

Hitherto  "route  step"  has  been  the  order  in  marching  long  dis- 
tances, and  probably  this  is  best  today  for  troops  which  are  not  well 
practised  in  marching.  Experience  in  the  present  world  war  indicates 
that  when  the  load  is  properly  distributed  greater  distances  can  be 
accomplished  by  keeping  step  instead  of  marching  in  "route  step." 
This  applies  to  troops  well  trained  in  this  method  of  marching. 

When  preparing  to  perform  heavy  physical  labor  the  sensible  man 
discards  unnecessary  clothing,  loosens  the  collar,  rolls  up  the  sleeves 
and  dons  garments  which  enable  him  to  have  a  maximum  freedom  of 
action.  In  other  words  he  prepares  to  do  heavy  work.  Marching 
troops  are  doing  heavy  work  and  should  prepare  for  its  performance. 

If  the  weather  is  warm  the  men  should  be  permitted  to  loosen  col- 
lars, roll  up  sleeves,  or  loosen  garments  which  retard  heat  radiation. 
Green  leaves  or  a  wet  handkerchief  worn  under  the  head  dress  will 
afford  protection  against  the  direct  rays  of  the  sun. 

Bandoliers  or  other  straps  which  cross  the  front  of  the  chest  should 
not  be  allowed,  and  for  the  same  reason  tight  fitting  garments  should 
not  be  allowed  to  interfere  with  the  functions  of  the  heart  and  lungs 
by  making  compression  upon  the  thorax. 

The  troops  should  march  in  column  of  squads  unless  the  weather 
is  very  hot,  when  column  of  twos  will  enable  better  heat  radiation. 

In  cold  or  disagreeable  weather  the  men  on  the  outer  files  should 
exchange  places  with  those  on  the  inner  at  frequent  and  regular  inter- 
vals. This  equalizes  the  exposure  and  prevents  the  men  on  the  flanks 
of  the  column  from  bearing  the  brunt  of  cold  winds  and  weather. 

Each  man  carries  a  load  approximating  55  pounds  in  weight  and 
has  most  of  it  on  his  back,  consequently  a  forward  inclination  of  the 
body  is  necessary  to  maintain  balance,  and  considerable  training  is 
necessary  to  enable  marching  in  this  position  of  load  carrying. 

Feet. — Naval  forces  living  on  board  ship  and  accustomed  to  the 
smooth  wooden  decks  on  which  men  frequently  go  bare  foot  are  at  a 
disadvantage  when  they  are  placed  on  shore  in  campaigning.  Their 
feet  have  to  be  hardened,  and  they  really  have  to  learn  to  march  before 
long  distances  can  be  covered  at  an  average  speed  without  considerable 
discomfort. 

Feet  frequently  become  hot  and  swollen  during  the  march,  If 
halts  are  made  near  running  streams  much  comfort  can  be  had  by 


ON   THE   MARCH 


341 


loving  shoes  and  putting  the  feet  in  cold  water  for  a  moment  or  two, 
not  sufficiently  long  to  macerate  epithelium  more  than  is  already 
:ing    place    in    sweat-soaked    socks.     The    feet    should    then    be 
>roughly  dried. 

Often  it  will  be  found  conducive  to  comfort  to  exchange  socks  from 
foot  to  the  other.     In  this  way  pressure  from  wrinkles  in  the  sock 
be  completely  prevented,  and  if  this  is  not  possible  the  exchange 
effect  removal  of  the  pressure  to  another  skin  area,  thereby  prevent- 
possible  blistering.     Talcum  may  be  dusted  into  the  socks. 
Holes  in  socks  are  the  most  productive  causes  of  blisters.     The 
;es  of  the  holes  tend  to  roll  and  produce  damaging  pressure  upon 
;.bjacent  skin  areas. 

When  blisters  have  formed  they  should  be  painted  with  iodine, 
lined,  dried,  and  repainted  with  iodine,  then  covered  with  a  bit 


127. — Figure-of-eight  strap  over  the  instep  prevents  blistering  resulting 
from  friction  of  the  heel  by  the  counter  of  the  shoe.  Note  the  position  of  the  heel  as 
it  is  raised  from  the  ground.  The  dotted  outline  shows  how  the  heel  rises  in  the  shoe. 
The  strap  prevents  this. 

of   -u-rilo  gauze  under  adhesive  plaster.     The  gauze  should  be  small 
in  area  and  consist  of  only  a  layer  or  two. 

Shoes  should  be  snugly  laced  to  prevent  charing.     A  leathern  strap 
forming  a  figure-of-eight  over  the  instep  will  prevent  the  up  and  down 

chafing  of  tin-  loose  shoes  upon  the  heels. 

Corns  should  be  soaked  in  a  warm,  weak,  alkaline  bath  and  pared 
well,  following  which  a  daily  coat  of  salicylic  acid  30  grains  to  the 
dram  of  Hi  xile  collodion  should  he  applied.  In  a  few  days  the  corn  may 
moved  ea>ily  after  soaking.  Ii  is  well  to  paint  the  surrounding 
skin  with  vaseline  or  ><>me  oily  preparation  in  order  to  limit  the  effect 
of^the  collodion  mixture  to  the  area  of  the  corn  and  to  prevent  injury 
to  healthy  skin. 


342  NAVAL    HYGIENE 

The  socks  should  be  washed  at  the  end  of  each  day's  march  and 
dried  whenever  possible  during  the  night. 

Toe  nails  should  receive  careful  attention.  They  should  be  pared 
squarely  across,  should  be  kept  well  cleaned,  and  should  not  be  per- 
mitted to  grow  long.  Long  nails  are  very  apt  to  cause  injury  to  the  skin 
of  the  toes  with  danger  of  infection.  Further,  when  the  great  toe  nail  is 
permitted  to  grow  longer  than  it  should,  soreness  is  caused  at  the  base 
of  the  long  nail  as  result  of  impinging  upon  the  inner  surface  of  a  shoe 
which  is  relatively  too  short.  Not  uncommonly  nails  are  injured 
sufficiently  to  cause  their  exfoliation  and  much  discomfort. 

The  skin  of  the  feet  should  be  kept  clean  as  possible,  thereby  lessen- 
ing infection. 

Bromidrosis,  or  excessive  sweating  of  the  feet,  may  cause  much 
discomfort  as  well  as  odor.  Relief  is  obtained  by  bathing  the  feet 
in  one  of  the  following  solutions,  viz.,  2  per  cent,  formalin,  alum  5 
grains  to  the  ounce,  or  i  to  1000  bichloride  of  mercury. 

Tender  feet  should  be  bathed,  then  sponged  with  alcohol.  When 
practicable  elevation  of  the  feet  will  give  relief. 

Camp  Site. — At  times  it  becomes  necessary  for  a  naval  medical 
officer  to  make  recommendation  concerning  camp  site  for  bluejackets 
and  marines  operating  ashore. 

More  commonly  these  forces  will  be  landing  under  the  protection 
of  their  own  guns,  but  may  advance  inland  where  the  ship  no  longer  can 
be  depended  upon  for  fresh  water  supply. 

If  a  body  of  troops  is  in  face  of  the  enemy  the  best  must  be  made  of 
bad  conditions,  but  if  not  in  face  of  the  enemy,  and  a  camp  is  to  be 
occupied  for  so  long  as  forty-eight  hours,  sanitary  considerations  should 
control. 

When  possible  a  camp  site  should  be  beside  a  stream  which  will 
afford  sufficient  water  supply  for  the  command  and  animals  attached 
thereto. 

For  tactical  reasons  an  advancing  column  may  cross  a  stream  before 
camping  beside  it. 

The  camp  site  should  be  established  on  sloping  ground.  If  weather 
appears  threatening  it  should  be  remembered  that  a  stream  suddenly 
becoming  swollen  may  compel  precipitate  abandonment  of  camp  site 
located  too  near  its  banks.  The  soil  should  be  sandy  and  preferably 
covered  with  grass.  This  will  give  a  minimum  amount  of  mud  in 
rainy  weather.  The  ground  water  should  stand  not  less  than  n  feet 


ON   THE    MARCH  343 


below  the  surface.  The  site  should  be  selected  with  reference  to  food, 
f  iK'l.  and  water  supplies,  as  well  as  accessibility.  The  site  should  be  on 
the  lee  side  of  the  hill  with  reference  to  prevailing  winds  in  cold  weather 
and  should  be  at  or  near  the  top  of  the  hill  so  as  to  get  the  breeze  in 
warm  weather.  It  should  be  to  windward  of  marshes  from  which 
mosquitoes  might  be  blown. 

In  approaching  the  camp  site  a  sufficient  number  of  men  should 
be  sent  in  advance  of  the  main  body  to  guard  the  water  supply  and  to 
establish  latrines  and  urinals,  and  have  them  ready  upon  the  arrival 
of  their  comrades.  This  prevents  soil  pollution.  The  line  of  the 
latrines  should  be  to  leeward  of  the  camp  and  as  far  from  the  kitchens 
and  mess  rooms  as  possible. 

To  prevent  pollution  of  the  water  supply  a  guard  should  be  placed 
around  it,  and  a  fence  should  be  put  about  it  in  case  a  pool  or  reservoir 
is  1  )cing  used.  If  on  or  near  a  flowing  stream  the  site  chosen  for  drinking 
water  should  be  situated  above  that  chosen  for  watering  the  animals, 
an  1  still  further  down  stream  should  be  selected  a  place  where  washing 

y  be  done. 

The  picket  lines  should  be  to  leeward  of  the  camp. 

The  picket  lines  should  be  kept  clean  of  manure  to  prevent  the 
ing  of  flies  and  where  possible  they  should  be  burned  off  with 

w  saturated  with  kerosene  once  each  week. 

Trench  Foot. — Trench  foot  or  "frost-bite"  is  due  to  muscle  inertia 
an  1  prolonged  exposure  to  cold.  Extremes  of  cold  are  not  necessary 
to  produce  trench  foot.  It  may  develop  at  40°?.  Contact  of  water 
with  the  skin  predisposes  to  it.  Any  venous  stasis  predisposes  to  the 
trench  foot,  consequently  if  leggins,  puttees,  or  boots  are  too  tight  the 
condition  is  more  easily  produced.  The  symptoms  resemble  prelimi- 
nary peripheral  neuritis,  followed  by  gangrene  in  severe  cases. 

Prophylaxis. — Drain  trenches  or  raise  level  of  stance  by  use  of  boxes, 
fagots,  boughs,  etc.  Rub  whale  oil  or  grease  thoroughly  into  the  skin 
of  :he  foot  and  leg.  The  Indians  of  Tierra  del  Fuego  rub  oil  into  their 
skins  to  prevent  heat  radiation  from  skin  and  to  shed  water.  They 
wear  no  clothing.  If  necessary  to  stand  in  water  long  rubber  boots 
should  be  worn.  Even  these,  however,  become  wet  on  the  inside  from 
:  lira  lion.  Two  pairs  of  socks  should  be  worn. 

Shoes,  puttees,  and  leggins  should  not  interfere  with  peripheral 
circulation.  When  resting  the  legs  should  be  straightened  out  and 

t  ck-vated.     It  is  believed  that  the  pressure  of  the  "fire-step"  in  the 


344  NAVAL  HYGIENE 

trench  upon  vessels  and  nerves  at  the  popliteal  space  may  be  a  pre- 
disposing cause.  Proper,  warm,  stimulating  nourishment  and  hot 
soups  should  be  provided.  The  individual  should  not  sleep  in  a 
"curled  up"  posture,  but  with  legs  and  thighs  extended  to  facilitate 
circulation. 

Those  exposed  to  cold  should  keep  in  motion  in  so  far  as  conditions 
will  allow.  Medical  Director  F.  L.  Pleadwell,  U.  S.  Navy,  has  seen 
most  gratifying  results  from  injection  of  oxygen  into  the  frost  bitten 
areas.  Gangrene  appeared  to  be  prevented  in  all  but  three  cases 
observed  by  him. 

Trench  Kidney  or  Trench  Nephritis. — This  is  a  condition  which 
is  poorly  understood.  There  is  reason  to  believe  that  it  is  due  to  the 
prolonged  exposure  incident  to  hard  service  and  cold,  wet  stations  in 
the  trenches,  i.e.,  that  it  is  merely  acute  nephritis.  There  are  some 
who  regard  it  as  a  specific  infectious  disease,  the  cause  of  which  is  un- 
known. Fecal  streptococci  have  been  considered  the  cause. 

At  one  station  during  the  winter  of  1916-17  the  mortality  rate  for 
trench  kidney  was  so  high  as  4  per  cent.  The  symptoms  of  the  disease 
are  those  of  nephritis  plus  marked  changes  in  the  lungs.  The  pulse 
is  usually  full  and  bounding  and  the  temperature  varies  up  to  104°. 

Prophylaxis. — Avoid  exposure.  Practise  hygienic  living.  Since  no 
specific  organism  is  known  to  cause  the  disease  there  appears  to  be 
no  means  to  attack  the  disease  from  the  standpoint  of  serum  therapy 
or  vaccines. 


CHAPTER  XXVI 
MALINGERING 

Occasionally  a  malingerer  is  found  among  those  who  desire  to 
separate  themselves  from  a  service  which  is  distasteful  to  them  for 
various  reasons,  e.g.,  homesickness,  family  trouble,  etc.;  or  those  who 
desire  to  avoid  a  disagreeable  task;  or  among  the  few  psychopathic 
individuals  who  are  encountered  in  the  service.  Malingerers  may  be 
classified  as: 

(a)  Those   who  willfully  exaggerate  deformities,  or  the  results  of 
injuries; 

(b)  Those  who,  without  evident  anatomical  basis,  feign  disease  or 
produce  symptoms  by  drugs  or  other  agents. 

(a)  The  class  who  willfully  exaggerate  deformities  or  the  result  of 
injuries  is  a  difficult  one  to  handle.     The  conscientious  medical  officer 
often  feels  chagrined  at  his  inability  to  demonstrate  the  malingering 
which  he  feels  sure  is  being  practised.     The  writer  had  an  applicant  for 
treatment  who  had  received  a  fracture  of  the  clavicle  years  previously. 
He  alleged  that  he  suffered  incapacitating  pain  whenever  called  upon 
to  perform  any  manual  labor.     The  condition  did  not  improve  under 
rest  and  massage.     When  he  was  found  pitching  a  baseball  game  on 
shore  after  having  been  treated  that  very  day  for  inability  to  perform 
his  duties  it  was  believed  that  a  case  of  malingering  had  been  established. 

The  nervous  effects  produced  as  result  of  some  stress  frequently 
lead  patients  to  make  claims  of  unusual  suffering.  All  such  cases 
in  which  there  is  demonstrable  evidence  of  injury  with  deformity  are 
cases  which  must  be  treated  very  carefully  to  avoid  injustice. 

(b)  The  second  group  of  malingerers  is  one  which  taxes  the  ingenuity 
and  wit  of  the  medical  examiner.     The  writer  has  seen  feigned  epilepsy 
in  which  a  fearsome  frothing  at  the  mouth  was  produced  with  soap 
very  much  after  the  fashinn  of  Kipling's  "Sleary.". 

Persistent  vomiting  has  been  found  in  one  case  to  be  due  to  the 
swallowing  of  snuff  taken  for  that  purpose. 

345 


346  NAVAL   HYGIENE 

A  man  who  has  general  oedema  of  an  extremity  should  be  examined 
stripped.  This  facilitates  accurate  diagnosis  and  precludes  possibility 
of  the  condition  having  been  produced  by  a  constricting  band  placed 
at  shoulder  or  groin  to  retard  return  circulation. 

In  some  of  the  continental  European  armies  individuals  desiring 
to  avoid  compulsory  military  service  have  resorted  to  self -mutilation, 
such  as  cutting  off  fingers.  A  certain  class  of  men  with  some  medical 
training  have  abetted  malingerers  by  dilating  the  inguinal  canals 
with  the  fingers  in  order  to  render  them  patulous  and  produce  an  in- 
capacitating hernia.  Others  have  submitted  to  the  injection  of 
paraffin  at  sites  where  the  tumors  would  appear  to  produce  an  effect 
which  would  unfit  them  for  military  service. 

If  there  is  suspicion  of  malingering  the  temperature  should  be 
carefully  taken,  the  patient  being  constantly  watched.  Friction 
on  the  trouser  leg,  contact  with  a  steam  radiator,  or  immersion  in  warm 
water  will  raise  the  mercury  column  in  a  thermometer  so  treated. 
Also  the  malingerer  may  have  just  rinsed  his  mouth  with  water,  hot 
or  very  cold,  and  corresponding  effect  will  be  produced  upon  the  ther- 
mometer which  is  supposed  to  register  his  actual  temperature.  In  any 
case  where  there  is  reasonable  doubt  the  individual  should  be  put  in 
bed  and  kept  there  on  milk  diet.  If  he  is  sick  no  better  expectant 
treatment  can  be  practised.  If  he  is  well  no  more  disagreeable  treat- 
ment can  be  employed  than  milk  diet,  recumbent  posture,  and  en- 
forced use  of  a  bedpan.  The  malingerer  recovers  rapidly  with  such 
treatment. 

Diarrhoeal  and  dysenteric  symptoms  should  be  carefully  inquired 
into.  Occasionally  an  individual  complains  of  such  symptoms  to 
avoid  duty.  He  should  be  required  to  use  the  stool  in  the  sick  bay. 
Inspection  has  revealed  constipation  rather  than  diarrhoea  in  some 
cases. 

The  bed  wetter  is  not  infrequently  encountered.  He  should  be 
treated  with  consideration  and  given  medication  and  instructions 
looking  toward  the  prevention  of  his  condition.  This  is  a  common 
form  of  malingering.  If  malingering  is  suspected  the  individual 
should  be  called  and  made  to  go  to  the  closet  once  every  half  hour 
during  the  night.  This  will  usually  keep  his  bed  dry  and  cure  his 
symptoms. 

Partial  or  complete  blindness  is  feigned  at  times.  Partial  blindness 
may  be  detected  by  one  of  the  several  methods  of  employing  prisms. 


MALINGERING  347 

The  aid  of  the  eye  specialist  usually  must  be  invoked  since  the  appara- 
tus is  not  at  hand  aboard  ship. 

The  detection  of  feigned  complete  blindness  is  far  more  difficult  and 
depends  upon  a  careful  watch  of  the  case.  Detection  may  be  accom- 
plished at  times  by  the  sudden  employment  of  ruses  such  as  thrusting 
an  object  at  the  eye  as  if  to  stick  it  into  the  eye.  Preparation  for  pre- 
tended operation  on  the  eye  for  the  relief  of  the  condition  will  bring 
confession  by  the  patient. 

Feigned  color  blindness  is  easy  of  detection  by  the  examiner  who 
is  versed  in  the  examination  for  defective  color  perception. 

Defective  hearing  in  one  or  both  ears  may  be  feigned.  A  careful 
watch  of  a  patient  if  the  otoscopic  findings  are  negative  will  be  of  value. 
The  clink  of  a  coin  dropped  behind  him  is  very  apt  to  make  the  patient 
look  around. 

Myalgia  is  feigned.     The  energetic  treatment  of  it  is  usually  suffi- 

nt  to  cure  the  malingerer. 

Occasionally  a  mental  disorder  is  feigned.  This  requires  careful 
study.  The  individual  who  is  willing  to  feign  mental  disease  is  suf- 
fering from  mental  disorder  and  the  sooner  he  is  discharged  from 
service  the  better. 

Malingerers  employ  drugs  for: 

(</)   Constitutional  effect; 
Local   effect. 

(a)  Purgatives  for  producing  diarrhoeas  and  opiates  for  constipating 
effect  have  been   used.     Santonin  produces  symptoms  which    cause 
the  patient  to  appear  quite  sick  and  has  been  taken  for  this  purpose. 
Numerous  other  drugs  have  been  employed  for  the  production  of  con- 
stitutional effect  with  more  or  less  success. 

(b)  The   local   effect    of   drills   is   manifested   by    skin  eruptions, 
vesication,  etr.     ('rot  on  oil  has  been  used  for  this  purpose  as  have 

vcsu-ai  •' 


The  writer  attended  a  m  attendant  on  tlu-  I".  S.  S.   Bancroft  who  en- 

•ed  to  be  sent  to  the  hospital  just  prior  to  >ailinj:.      1  1  rtain  symptom- 

referable  to  the  Castro  -intsi-tinal  trad  and  stated  that   he  had  tape  worm.  .  After 
appropriate  treatment  had  re-ulted  in  negative  findings,  and  the  ship  | 
he  confessed  to  his  effort  to  !»«•  si-nt  to  a  hospital.  <tatin«  that  he  feipned  tape  worm 
he  purpose. 


CHAPTER  XXVII 
PERSONAL  HYGIENE 

The  personnel  of  the  U.  S.  Naval  forces  embraces  a  narrower  field 
than  that  which  must  be  considered  by  the  general  hygienist.  It 
includes  the  male  sex  from  ages  of  sixteen  to  sixty-four  on  active 
service,  and  to  greater  age  than  this  among  those  on  the  retired  list. 

However,  the  rates  of  morbidity  and  mortality  published  for  the 
United  States  Navy  refer  solely  to  officers  and  men  on  the  active  list; 
i.e.,  below  the  age  of  sixty-four. 

These  men  come  from  all  stations  of  life,  from  all  sections,  and 
from  every  environment.  They  are  taken  into  surroundings  different 
from  those  to  which  they  are  accustomed,  and  come  in  contact  with 
physical  forces  little  known  to  them.  Each  is  a  different  mental 
unit,  each  must  be  reckoned  with  separately,  and  each  must  also  con- 
form to  the  many  rules  and  regulations  which  make  possible  the 
existence  of  an  organization  like  the  Navy. 

Obviously,  the  habits  of  the  men  composing  the  naval  personnel 
vary.  Among  the  crew  of  a  large  ship  carrying  800  to  1000  men,  or 
more,  we  are  apt  to  find  the  same  manifestation  of  human  frailty 
which  would  be  found  among  the  same  number  of  men  of  the  same 
class  elsewhere. 

Contentment  and  Work. — There  is  no  truer  saying  than  that  "  the 
devil  always  finds  work  for  idle  hands  to  do."  Idleness  breeds  bad 
habits  and  excesses.  The  day's  work  should  be  so  arranged  that  the 
men  are  kept  busy.  Indolence  affords  time  for  excesses  in  the  use  of 
tobacco,  alcohol,  morphine,  cocaine,  or  other  drugs,  excessive  venery, 
or  perversion  of  the  generative  functions. 

Work  or  amusement  should  occupy  the  hours  of  each  day  so  as  to 
crowd  out  the  tendencies  which  inevitably  come  when  time  hangs 
heavily  on  their  hands.  Weary  men  should  go  to  rest  and  sound  • 
sleep  at  the  end  of  a  tired  day. 

Gambling  is  a  frequent  accompaniment  of  the  bad  habits,  and 
is  a  breeder  of  strife,  discontent,  or  dissension. 

348 


PERSONAL   HYGIENE 


349 


The  moving  picture  show  has  done  much  to  afford  diversion  for 
men  attached  to  the  larger  ships,  and  in  a  big  fleet  the  exchange  of 
tilrvs  enables  the  establishment  of  a  circuit  which  allows  a  different 
exhibition  almost  every  night  when  weather  conditions  are  favorable 
for  spreading  the  screen  on  deck. 

Theatrical  performances  by  members  of  the  crew  often  afford 
considerable  diversion  to  those  interested  in  vaudeville,  and  no  little 


Fu,.    128. — The  crew's  reading  room  on  a  battleship. 

entertainment  and  amusement  results  from  the  rehearsals  preliminary 
,  to  t  ie  performances.  The  theater  ship  is  now  an  institution  in  the 
I  British  Navy. 

Boxing  and  wrestling  matches   under  proper   supervision  afford 
deshnbU'   diversion.     Athletic  contests  of  all   sorts  are  entered  into 
I  with  enthusiasm  by  the  men. 

Intership  football  and  baseball  matches  are  of  great  interest  to 
officers  and  men,  as  are  the  boat  races  and  swimming  contests. 

After  a  baseball  game  on  shore  between  two  rival  teams  the  victorious  team  in 


350 


NAVAL  HYGIENE 


returning  to  its  ship  accepts  as  one  of  its  privileges  the  right  to  encircle  the  ship  of 
the  defeated  team  and  rub  in  the  defeat  in  a  very  thorough-going  manner. 

One  has  only  to  see  the  several  boats  returning  to  a  ship  carrying  the  victorious 
baseball  team  with  a  brass  band  and  enthusiastic  rooters,  making  a  complete  circle 
around  the  ship  of  the  defeated  team,  to  realize  how  much  interest  is  aroused  by 
these  games. 

Lectures  and  concerts  also  do  their  part  in  entertaining  men  on 
whose  hands  time  would  hang  heavily  after  the  day's  work  is  done. 


FIG.  129.- 


-Recreation.      Note  the   method   of   securing   the   legs   of      the  mess 
table  and  stowing  it  on  racks  overhead. 


Cleanliness. — The  medical  officer  should  aid  in  every  way  in  the 
effort  to  enforce  personal  cleanliness  among  the  men.  Most  of  them 
will  seldom  require  admonition,  but  some  there  are  who  will  tend  to 
revert  to  habits  of  filth,  established  early  in  life. 

Cleanliness  promotes  comfort,  self-respect,  improves  morale,  and 
tends  to  reduce  animal  parasitic  disease  infection  through  the  skin, 
as  well  as  bacterial  infections  through  the  same  route. 


Regularity 


PERSONAL   HYGIENE 


351 


jgularity  of  habit  as  to  meals  is  guaranteed  by  the  routine  of 
naval  life.  The  same  desirable  regularity  concerning  evacuating  the 
bowel  is  not  guaranteed.  The  more  or  less  sedentary  habit  of  men  on 
board  ship,  where  the  opportunity  for  physical  exercise  is  limited, 
tends  to  produce  constipation.  All  the  persons  should  be  urged  to  be 
regular  and  go  to  stool  at  a  fixed  hour  daily,  even  though  there  be  no 
urgent  inclination. 

The  human  animal  likes  to  eat  to  satisfaction  thrice  daily.  If 
waste  products  are  retained  he  must  eat  less,  defecate  more,  or  burst, 
lu-'ecation  is  the  most  satisfactory  of  the  three  courses. 

Members  of  the  crew  should  be  instructed  to  consult  the  medical 
officer  if  the  bowel  is  not  evacuated  daily,  or  at  most  every  forty-eight 
hours.  Cases  of  appendicitis,  intestinal  obstruction,  fecal  impaction 
and  the  like  thus  may  be  prevented. 

Men  should  be  urged  to  drink  pure  water  frequently,  especially 
before  breakfast,  and  to  carry  or  provide  pure  water  for  themselves 
when  ashore,  if  the  water  on  shore  is  of  questionable  parity. 

During  the  routine  life  aboard  ship  considerable,  but  not  enough, 
physical  exercise  is  performed.  The  "setting  up"  drill  aids  in  main- 
taii  ing  good  physical  tone.  It  seems  desirable  that  all  persons  on 
board  ship  should  take  this  exercise  daily,  especially  those  whose 
duties  keep  them  between  decks,  such  as  storeroom  keepers,  engineer's 
ion  e,  etc. 

The  system  in  common  use  in  the  Navy  is  that  adopted  from  the 
Swedish  sy>tem  with  necessary  modifications.  This  system  is  most 
excel  lent  in  that  it  tends  toward  symmetrical  development  of  the  body, 
and  a  quick,  accurate,  coordinated  control  of  the  muscles  rather  than  an 
overdevelopment  of  special  groups  for  the  performance  of  feats  of 
strength. 

Underclothing  should  be  kept  clean,  and  should  be  washed  fre- 
quently. Cleanliness  of  the  skin  surface  may  be  maintained  with  the 
aid  of  so  little  as  a  quart  of  fresh  water  for  bathing  purposes  each  day. 
This  amount  of  water  will  not  be  satisfactory  to  those  accustomed  to 
a  daily  bath,  but  it  will  suffice  to  keep  the  body  decently  clean.  In 
modern  navies  it  is  never  found  necessary  to  practise  such  economy 
aboard  ship.  All  should  bathe  and  put  on  clean  underwear  before 
going  into  action  in  order  to  lessen  probability  of  infection  of  wounds. 

A  wash  basin  with  knee  or  foot  control  faucet  and  paper  towels 
should  be  placed  at  each  water  closet  in  order  that  ordinary  cleanliness 


352  NAVAL  HYGIENE 

may  be  possible,  and  as  a  measure  of  prevention  of  spread  of  disease, 
e.g.,  typhoid,  gonorrhea,  dysentery,  etc. 

Tooth  brushes  should  be  used,  and  their  use  enforced  in  order  that 
the  mouths  of  the  men  may  be  kept  clean.  The  use  of  the  tooth  brush 
tends  to  reduce  the  bacterial  content  of  the  mouth  and  to  render  less 
frequent  the  serious  as  well  as  milder  throat  infections. 

The  dangers  incident  upon  the  common  use  of  razor,  towel,  pipe, 
comb,  brush,  etc.,  are  too  apparent  to  require  more  than  mention. 

The  loan  of  pipes,  cigar-holders,  and  of  partially  smoked  cigars, 
as  well  as  of  toilet  articles  and  drinking  cups,  should  not  occur. 

The  loan  of  clothing  and  especially  of  underclothing  should  be 
discouraged,  as  skin  infections,  animal  or  vegetable,  thus  may  be 
transferred. 

Just  here  a  word  may  be  said  about  the  loan  of  the  tobacco  bag. 
Several  men  are  sitting  in  a  group.  One  man  takes  out  his  tobacco 
bag  to  roll  a  cigarette  or  fill  his  pipe.  His  left  hand  being  engaged  with 
the  pipe  or  cigarette,  he  brings  the  bag  to  his  mouth,  takes  the  string 
between  his  lips  and  teeth,  and  pulls  on  it  to  close  the  bag.  In  so 
doing  the  string  becomes  wet  with  saliva  and  the  borrower  who  repeats 
the  performance  just  described  is  afforded  ample  opportunity  to  con- 
tract any  disease,  the  germs  of  which  may  be  in  the  saliva. 

The  use  of  tobacco  is  prevalent.  It  is  not  believed  that  indulgence 
in  the  moderate  use  of  this  drug  is  especially  harmful  to  the  average 
mature  man.  Some  men  are  harmed  by  the  moderate  use  of  tobacco 
and  should  not  indulge  in  it.  Buckets  of  water  may  be  poured  into  a 
large  cask  which  still  stands  ready  to  receive  more  buckets  of  water, 
but  there  comes  a  time  when  the  addition  of  one  single  drop  of  water 
will  cause  overflow  from  the  cask  which  hitherto  has  received  water  by 
the  bucketful.  It  appears  that  a  similar  condition  obtains  with  refer- 
ence to  the  ingestion  of  certain  foods  and  drugs.  Their  presence  is 
borne  by  the  body  without  murmur  until,  just  as  with  the  cask,  there 
comes  a  time  of  overflow.  Many  men  have  used  tobacco  freely  from 
youth  to  ripe  old  age  without  consciousness  of  ill  effect.  Its  use  in 
early  life  is  to  be  deprecated. 

Especially  pernicious  is  the  cigarette.  Its  use  by  young  people  pro- 
duces an  effect  upon  the  body  processes  and  upon  the  nervous  system 
and  heart  which  is  well  known,  and  which  should,  so  far  as  possible,  be 
prevented,  as  it  goes  far  to  spoil  the  clear  head,  keen  eye,  and  steady 


PERSONAL  HYGIENE  353 

hand.  The  sale  of  cigarettes  in  the  ship's  canteen  has  been  discon- 
tinued by  official  orders. 

Coffee. — Excessive  use  of  coffee  is  pernicious  and  should  not  be 
permitted.  Ingestion  of  five  or  six  cups  of  coffee  (as  is  done  at  times) 
is  harmful. 

Alcoholic  Beverages. — Abuse  of  alcoholic  beverages  is  of  course  en- 
countered. When  called  upon  to  pronounce  official  opinion  as  to 
whether  a  given  person  is  under  influence  of  an  alcoholic  beverage,  one 
should  always  carefully  examine  before  expressing  opinion.  If  the 
individual  should  be  tried  by  court-martial  for  drunkenness,  and  the 
surgeon  who  has  made  a  superficial  examination  should  be  called  as  a 
medical  witness  for  the  prosecution,  the  counsel  for  the  defense  easily 
could  elicit  the  statement,  "I  just  looked  at  him  and  knew  he  was 
drunk."  This  would  invalidate  the  testimony  of  the  medical  witness, 
for  the  above  statement  is  tantamount  to  saying:  "I  did  not  examine 
the  accused." 

Spirituous  liquors,  under  the  regulations,  are  not  permitted  on  board 
ship  except  in  the  custody  of  the  medical  department  for  medical 
purposes. 

Lighter  alcoholic  beverages  formerly  were  permitted  in  the  wine 
mess  of  the  wardroom  mess,  but  now  are  not  allowed  by  regulation. 

The  smuggling  of  liquor  on  board  is  summarily  punished.  Men 
returning  from  liberty  are  sometimes  found  to  have  one  or  more  "dogs" 
(bottles  of  whiskey)  with  them.  Such  men  are  punished.  Women 
visiting  ships  not  infrequently  bring  bottles  of  liquor  under  their 
sk.rts  and  sell  them  to  the  men. 

When  drinking  is  found  among  men  aboard  ships  in  port  it  is  well 
quietly  to  keep  a  close  watch  upon  small  boats  that  hover  around  the 
ship,  especially  at  night.  Under  cover  of  darkness  such  a  boat  may 
slip  up  silently  to  the  ship's  side,  avoiding  the  regularly  used  ship's 
ladders,  and  attaching  a  bottle  of  whiskey  to  a  cord  lowered  from  an 
air-port,  or  overhang,  they  ply  their  nefarious  trade. 

Also  the  bumboats,  small  boats  which  come  out  to  the  ship  and 
receive  permission  to  sell  fruit,  candies,  cakes,  etc.,  to  the  crew,  must 
be  carefully  watched.  Bumboats  are  not  now  allowed  (need  for  them 
is  not  felt  since  the  establishment  of  the  canteen),  but  an  elastic  con- 
struction of  this  prohibition  often  enables  the  purchase  of  fresh  eggs  and 
fruit. 

Bottled  drinks  should  not  be  purchased  from  such  sources,  for  the 

23 


354  NAVAL  HYGIENE 

water  of  which  they  are  made  may  be  very  bad.  If  these  drinks  are 
permitted  to  be  sold  a  bottle  selected  at  random  and  examined  may 
be  found  to  contain  gin,  despite  its  mendacious  "soft  drink"  label.  In 
the  tropics  men  frequently  like  to  purchase  cocoanuts.  There  is  no 
objection  to  this  practice  as  they  are  highly  nutritious,  although  indi- 
gestible. However,  one  should  be  on  one's  guard  and  inspect  the  cocoa- 
nuts  carefully,  for  in  some  places  they  have  been  found  to  be  filled  with 
rum  or  alcoholics  introduced  through  the  "eyes  of  the  nut"  after  drain- 
ing away  the  milk. 

Shellac  is  much  used  aboard  ship.  The  shellac  is  "  cut"  or  dissolved 
in  alcohol.  Although  the  alcohol  is  kept  under  careful  watch,  i.e., 
lock  and  key,  it  not  infrequently  happens  that  after  shellac  is  issued  for 
use  it  is  obtained  by  men  who  add  water  to  it,  thus  precipitating  the 
shellac,  pour  off  the  supernatant  fluid,  and  add  some  sugar  to  this  mix- 
ture of  alcohol  and  water,  thus  making  an  alcoholic  drink. 

Wood  alcohol  is  much  used  for  cutting  shellac.  It  is  cheap  and 
highly  poisonous.  Many  ignorant  people  may  fancy  that  it  is  grain 
alcohol  and  drink  it  with  most  disastrous  results. 

Several  instances  are  recorded  within  my  recollection  of  the  fatal 
poisoning  of  men  who  have  constituted  wood  alcohol  cocktail  parties. 
Such  serious  accidents  have  resulted  from  the  drinking  of  wood  alcohol 
that  its  use  in  the  Navy  has  been  prohibited. 

It  should  be  remembered  in  every  case  of  sudden  complete,  or  sud- 
den partial  blindness  in  persons  below  fifty  years  of  age  who  have 
neither  signs  of  inflammation  or  intraocular  disease,  nor  history  of 
concurrent  trauma,  that  wood  alcohol  intoxication  is  perhaps  most 
frequently  thus  manifested,  and  that  the  impairment  of  sight  is  apt  to 
be  permanent. 

When  serving  with  members  of  the  hospital  corps  who  are  not  tried 
men,  it  is  well  frequently  to  inspect  the  sherry,  port,  whiskey,  brandy 
and  alcohol.  It  is  not  enough  to  look  at  the  wrapped  bottle  on  the 
shelf.  It  may  be  empty.  It  may  be  filled  with  a  colored  substitute. 
It  may  be  greatly  diluted.  Special  care  must  be  taken  with  reference 
to  the  key  of  the  liquor  locker  and  its  custodian.  Desire  for  liquor 
causes  men  to  drink  bay  rum,  alcohol  off  specimens,  cologne  water, 
etc.  Compound  tincture  of  cardamom  is  a  favorite  with  the  dip- 
somaniac as  is  paregoric.  Users  of  Peruna,  stomach  bitters  and 
other  nostrums  should  be  watched.  Drinking  coca  cola  should  be 
discouraged. 


PERSONAL   HYGIENE  355 

Similar  supervision  of  the  poisonous  and  habit-producing  drugs 
should  be  observed.  A  man  of  degraded  type  who  suffers  repeatedly 
with  "cramps,"  nausea,  etc.,  may  well  be  made  a  subject  of  close 
observation  to  detect  a  possible  opium  addiction. 

Cocaine  is  more  widely  used  than  is  supposed.  Its  habitues  are 
usually  of  most  degraded  type. 

Surgeon  Owens,  of  the  U.  S.  Naval  Medical  Corps,  recently  has 
invited  attention  to  a  superficial  ulceration  of  the  nasal  mucosa  result- 
ing from  the  snuffing  of  powdered  cocaine.  He  believes  this  to  be 
almost  a  pathognomonic  objective  sign  in  those  whose  condition  and 
habits  suggest  cocaine  addiction. 

Cordite  Eating. — Cordite,  a  high  explosive,  was  much  used  by  the 
British  in  the  Boer  War.  The  British  soldiers  were  furnished  with 
cartridges  containing  it.  Some  of  the  soldiers  acquired  the  "cordite- 
eating"  habit,  eating  the  powder  dry,  or  dissolved  in  beer  or  hot  water. 
It  causes  a  sense  of  exhilaration,  and  throbbing  of  the  head  with  in- 
toxication, and  in  about  twenty  minutes  sleep  comes  on.  From  this 
sleep  the  habitue  awakens  with  a  severe  thirst,  most  intense  headache, 
and  depression.  This  addiction  has  not  been  reported  in  our  service 
that  I  am  aware.  Of  course  absinthe  and  other  habit-producing  drugs 
may  be  used,  but  the  above  are  the  ones  chiefly  to  be  expected. 

Gasolene  Jag. — Occasionally  a  man  is  found  who  intentionally 
inhales  gasolene  fumes  for  the  purpose  of  getting  their  stimulating 
effect.  Such  individuals  exhibit  the  signs  and  symptoms  common 
to  the  stage  of  excitement  in  acute  alcoholic  poisoning.  The  odor 
of  alcohol  is  absent,  and  not  uncommonly  that  of  gasolene  may  be 
<K  rcted.  The  symptoms  may  grow  worse  until  convulsions  supervene. 
M1  ocular  incoordination  appears  to  be  less  than  in  case  of  alcoholic 
po  soning,  but  the  effect  upon  the  nervous  system  is  prompt  and  severe. 

Tattooing. — Tattooing  is  a  process  of  disfiguring  the  body  by 
embedding  in  the  derma  particles  of  India  ink  or  of  colored  pigment. 
It  is  difficult  to  understand  the  psychology  of  the  individual  who 
indulges  in  this  form  of  self -abuse.  It  is  common  among  the  savages 
who  appear  to  regard  it  as  a  form  of  adornment. 

In  the  Marquesas  Islands  it  has  been  a  custom  to  tattoo  one  quad- 
rant of  a  native's  face.  The  portion  of  the  island  from  which  he 
comes  is  indicated  on  his  face  by  the  quadrant  tattooed.  The  writer 
ha>  seen  a  white  man  whose  body  was  tattooed  almost  completely, 
producing  a  hideous  effect. 


356  NAVAL   HYGIENE 

The  various  designs  which  are  tattooed  into  the  skin  appear  to 
indicate  in  a  measure  the  traits  of  character  and  mental  trend  of  the 
individual  permitting  himself  to  be  tattooed;  for  instance,  an  American 
in  the  Orient  who  possessed  something  of  an  artistic  temperament 
had  his  body  almost  completely  tattooed  in  the  wistaria  pattern. 
Religious  emblems,  war-like  emblems,  nautical  designs,  grotesque  or 
comic  figures,  inscriptions,  and  obscene  figures  are  seen. 

Tattooing  is  prohibited  in  the  Navy  as  it  should  be.  It  readily 
may  lead  to  grave  consequences.  It  often  is  done  by  a  filthy  needle, 
and  the  writer  has  seen  more  than  one  case  of  syphilis  contracted  in 
this  manner,  the  initial  lesion  appearing  at  the  site  of  the  tattooing. 
Very  frequently  diffuse  cellulitis  of  the  forearm  results  from  tattooing. 
It  is  evident  that  almost  any  infection  may  be  inoculated  on  an  in- 
fected needle. 

Some  of  the  professional  tattooers  have  realized  this  and  boil  their 
needles,  yet  there  are  some  who  still  do  not  boil  their  needles  and  who 
mix  the  pigments  with  saliva  before  tattooing  it  into  the  skin.  The 
writer  has  seen  one  or  two  cases  of  large  slough  of  the  skin  resulting 
from  tattooing.  Tattooing  is  believed  to  be  less  common  than  formerly 
among  seafaring  men. 


[AFTER 
GAS 

Poisonous  gases  have  been  introduced  into  warfare  by  the  Germans. 
It  is  not  permissible  to  discuss  offensive  or  defensive  use  of  gases  at 
this  time  further  than  to  say  that  they  are  being  used  as: 

(a)  Drift  gas; 

(b)  Gas  shells. 

(a)  Drift  gas  is  liberated  to  windward  of  an  enemy  and  the  cloud 
of  gas  drifts  down  the  wind  to  him.     An  air  current  moving  at  the 
rate  of  about  5  miles  per  hour  is  most  favorable  for  the  use  of  drift 
gas.     This  method  appears  to  be  of  little  use  afloat. 

(b)  Gas  shells  are  charged  with  gas  in  compressed  form  or  liquid, 
w'lich  liberates  poison  gas  upon  explosion  of  the  shells. 

These  gas  shells  are  made  in  all  calibers.  Accuracy  of  fire  is  neces- 
sary to  their  effective  use.  Obviously  they  should  be  so  timed  as  to 
hi, rst  to  windward  of  an  enemy. 

From  standpoint  of  effect  the  gases  used  are: 

1.  Lethal; 

2.  Lacrimatory; 

3.  Sneezing. 

1.  The  lethal  gases,  such  as  chlorine,  bromine,  phosgene,  trichloro- 
mcthyl-chloroformate,  hydrocyanic  acid  gas,  and  the  like,  are  intended 
to   suffocate   immediately,   to  produce   fatal  pulmonary   oedema,  or 

rwise  to  kill  at  Oft 

2.  The  lacrimatory  gases  are  those  which  produce  active  irritation 
es  and  especially  mucous  membranes.      It  is  evident  that  sufficient 

concentration  of   the   lacrimatory  gases  would  prove  lethal.     Xylyl 
bromide  is  u-ed  as  a  lacrimatory  gas. 

hichlorethvlsulphid,  or  "mustard  gas"  (so-called  because  it  has 
th«-  odor  of  mustard)  is  one  of  this  type.  It  is  a  gas  liberated  from  a 
liquid  contained  in  some  of  the  gas  shells  and  when  it  comes  into  contact 
with  moisture  it  produces  burns. 

3*7 


NAVAL   HYGIENE 

These  are  superficial,  but  may  result  from  the  liquid  falling  upon 
the  clothing.  The  caustic  effect  of  the  gas  is  very  severe  upon  the  con- 
junctiva and  respiratory  mucosa. 

3.  Sneezing. — Diphenyl-chlorarsin  has  been  much  used  in  effort 
to  make  men  sneeze  incessantly  and  thus  interfere  with  their  efficiency. 
It  was  intended  also  to  force  removal  of  protective  gas  masks  and  thus 
expose  the  victim  to  other  poisonous  gases. 

Prophylaxis. — Avoid  surprise  attack.  Gas  masks  of  one  of  the 
several  good  types  should  be  used.  These  should  have  non-splinterable 
laminated  glass  or  celluloid  goggles,  preferably  the  former,  as  celluloid 
scratches  easily  and  is  inflammable.  Gas  masks  are  intended  to 
neutralize  the  gas  used  in  an  attack,  as  well  as  to  protect  the  head  and 
face. 

If  a  ship  is  overtaken  by  a  gas  cloud  her  ventilating  system  should  be 
stopped,  all  openings  closed  and  if  possible  she  should  speed  up  and 
get  out  of  the  cloud.  Similar  course  must  be  pursued  during  attack 
by  gas  shells. 

All  on  deck  should  wear  gas  masks. 


CHAPTER  XXIX 
SEASICKNESS 

Seasickness  is  a  condition  caused  by  the  motion  of  vessels  at  sea 
and  aggravated  by  disagreeable  odors  or  other  impressions  upon  the 
nervous  system  which  might  tend  to  produce  nausea  in  the  normal 
individual  ashore. 

Etiology. — Every  man  who  goes  to  sea  long  enough  and  tells  the 
truth  ha;  suffered  or  will  suffer  from  this  condition.  Its  obscure  eti- 
ology has  led  to  much  speculation  concerning  the  production  of  seasick- 
It  has  been  held  to  be  due  to  disturbances  in  the  semicircular 
canals,  and  in  support  of  this  thesis  it  is  claimed  that  deaf  mutes  do  not 
suffer  seasickness.  I  have  had  no  experience  of  this  but  have  seen 
seasickness  in  persons  who  had  lost  hearing,  including  bone  conduction 
in  one  ear. 

Others  claim  that  the  condition  is  due  to  disturbances  of  retinal 
images  and  the  effect  upon  accommodation  as  well,  in  looking  out 
upon  varying  wave  crests.  It  seems  probable  that  accommodation  is 
a  factor.  Many  seasick  persons  experience  great  relief  from  closure  of 
the  eyes. 

Still  others  hold  that  the  condition  is  produced  by  the  effect  upon 
the  splanchnic  s\>tem  as  result  of  the  unusual  jolting  of  the  stomach 
and  other  abdominal  organs. 

The  theory  has  been  advanced  that  seasickness  is  produced  by  im- 
pact of  blood  against  the  brain,  due  to  the  effect  of  the  motion  upon  the 
blood  in  the  circulating  vessels. 

The  vasomotor  system  appears  very  closely  associated  with  sea- 
sickii< 

Prophylaxis.  -The  above  are  theories.  Seasickness  is  a  fact.  Pre- 
vention  of  seasickness  certainly  is  favored  by  proper  function  of  the 
cnumctorks,  recumbent  posture,  cool  fresh  air  on  deck  near  middle  of 
th/  -hip,  the  wearing  of  a  belly-band,  and  avoidance  of  those  sights, 
odors  and  conditions  which  normally  would  disgust  or  nauseate  sus- 

f  ible  individuals. 

'359 


360  NAVAL  HYGIENE 

Diversion  is  an  important  factor.  I  have  seen  Alexander  Agassiz, 
when  notified  that  a  dredge  haul  was  about  to  be  landed  on  deck  from 
the  bottom  of  the  sea,  hurriedly  and  enthusiastically  leave  his  bunk 
in  quest  of  rare  scientific  specimens  of  marine  life.  Having  carefully 
examined  the  results  of  the  haul  he  would  be  overcome  by  mal  de  mer, 
from  which  he  was  a  great  sufferer,  and  with  difficulty  would  make  his 
way  back  to  his  bunk. 

The  case  of  a  lieutenant  who  came  up  for  promotion  to  grade  of  lieutenant 
commander  is  of  interest  in  considering  seasickness.  Eight  years  previous  to  his 
examination  for  promotion  he  suffered  an  attack  of  typhoid  fever.  The  official 
records  and  letters  from  the  various  medical  officers  with  whom  he  served  prior  to 
the  attack  showed  he  had  not  suffered  from  seasickness  more  than  is  the  experience 
of  the  average  sea-faring  man.  After  convalescence  from  typhoid  he  had  a  condition 
of  "neurasthenia"  which  was  manifested  in  good  part  by  exceptional  susceptibility 
to  seasickness.  When  examined  eight  years  after  the  attack  of  typhoid  he  showed 
certain  psychasthenic  symptoms,  the  chief  of  which  was  the  obsession  concerning 
seasickness.  He  stated  that  orders  to  a  sea-going  ship  would  make  him  sick  and  that 
he  was  unable  to  sleep  at  times  because  of  contemplation  of  such  orders. 

His  medical  history  was  one  containing  numerous  entries  of  incapacity  for  duty 
on  large  ships  and  small  as  result  of  seasickness.  He  is  robust,  73  inches  tall, 
weighs  over  200  pounds,  and  a  powerful  looking  man  whose  official  record  is 
one  of  excellent  performance  of  duty  and  of  commendation,  except  for  the  seasick- 
ness with  which  he  is  afflicted  whenever  he  goes  on  board  ship.  He  is  a  man 
of  excellent  habits,  and  repeatedly  has  tried  to  overcome  this  condition  which 
appears  to  have  developed  since  his  attack  of  typhoid. 

Careful  examination  of  his  ears,  including  the  internal  ear,  shows  no  abnormality, 
in  fact,  except  for  slight  tremor,  complaint  of  nervous  twitching,  non-use  of  limbs 
at  times,  occasional  pains  and  aches  in  various  parts  of  the  body,  he  appears  to  be 
a  man  of  exceptionally  good  health  and  strength.  It  may  be  added  that  his  habits 
with  reference  to  use  of  alcohol  and  tobacco  are  excellent.  After  a  struggle  during 
the  eight  years  which  have  elapsed  since  the  attack  of  typhoid  he  appears  to  be  a 
victim  of  chronic  seasickness  which  apparently  is  of  psychic  origin. 

In  the  aged  and  those  who  are  weak  and  emaciated  as  result  of 
disease,  seasickness  may  prove  a  serious  complication,  and  in  cases  of 
arterial  sclerosis  the  vomiting  may  produce  cerebral  hemorrhages.  In 
those  with  weak  abdominal  walls  hernia  may  result  from  violent  vomit- 
ing and  retching.  Usually,  however,  seasickness  is  harmless  in  its 
effects  and  the  sufferer  gets  little  sympathy  from  his  fellow  passengers. 
The  favorite  prescription  given  by  "old  salts"  to  those  who  are  seasick 
for  the  first  time  is  the  drinking  of  a  quart  of  sea  water.  It  is  eminently 
successful  in  causing  prompt  emesis,  but  this  is  the  best  that  can  be 
said  for  this  treatment. 


Each  case  c 


SEASICKNESS  361 


,ach  case  of  seasickness  appears  to  be  more  or  less  a  law  unto  itself, 
and  hard  and  fast  lines  of  prevention  or  treatment  are  difficult  to 
establish.  For  instance,  in  my  own  case  tendency  to  nausea  is  not  so 
great  on  a  full  stomach  as  when  the  stomach  is  empty,  and  I  have  found 
that  eating  gives  relief  when  nausea  is  marked.  Closing  the  eyes  gives 
relief  to  many  persons. 

Preparation  preliminary  to  sailing  will  add  comfort  in  the  case  of 
those  who  are  predisposed.  On  the  day  preceding  sailing,  the  bowel 
should  be  thoroughly  cleared  by  castor  oil,  seidlitz  powder  or  magnesium 
sulphate,  and  upon  going  on  board  ship  susceptible  individuals  should 
immediately  assume  a  recumbent  posture  on  deck,  if  the  weather  per- 
mits, in  a  steamer  chair  which  should  be  placed  about  the  middle  of  the 
ship — a  position  in  which  the  motion  probably  is  least  felt.  Belladonna 
or  atropine  stimulates  the  circulation  and  tends  to  throw  blood  to  the 
body  surfaces,  combating  the  mild  degree  of  shock  which  accompanies 
nausea.  One-thirtieth  of  a  grain  of  strychnine  thrice  daily  for  two 
days  before  sailing  tones  the  muscular  system  of  those  who  are  sus- 
ceptible and  is  thought  to  be  of  value. 

When  vomiting  is  commenced  the  usual  methods  of  treatment  of 
nausea  should  be  followed.  The  patient  should  be  given  small  quan- 
tities of  food  at  frequent  intervals,  and  it  must  not  be  forgotten  that 
the  seasick  individual  is  far  better  off  on  deck  day  and  night  than  he  is 
in  the  foul  air  between  decks  when  the  ship  is  battened  down  because 
of  weather. 

Diversion  and  will  power  play  a  large  role  in  prevention  of  seasick- 
ness. 

Bromides  and  other  sedatives  are  prescribed  at  times  for  the  relief 
of  seasickness.  It  is  not  clear  to  the  writer  that  depressants  should  be 
ad Timist ered  in  cases  of  shock;  and  seasickness  resembles  shock  in 
several  respects  not  the  least  of  which  is  depression.  The  exhibition 
of  these  drugs  is  apt  to  cause  further  discomfort  to  the  stomach. 


CHAPTER  XXX 
THE  NERVOUS  SYSTEM 

Constitutional  inferiority  and  the  constitutional  psychopathic 
state  readily  may  pass  the  recruiting  officer  and  remain  unnoticed 
until  some  stressful  condition  brings  a  psychosis  to  the  surface  or 
discovers  the  constitutional  inferiority. 

Excitement,  fear,  anger,  overwork,  excesses,  nostalgia,  monotony, 
or  injury  may  uncover  the  dormant  condition. 

The  strain  of  long  watches,  submarine  duty,  physical  discomfort, 
and  the  like  tend  to  break  even  the  rugged.  The  exactions  of  naval 
service  bear  heavily  upon  the  mental  weakling. 

EXHAUSTION  PSYCHOSIS 

While  training,  and  before  they  become  hardened,  men  may  present 
symptoms  of  exhaustion  psychosis  which  resemble  paresis. 

J.  Ramsay  Hunt  (Jour.  A.  M.  A.,  January  5,  1918)  has  described  a 
fatigue  syndrome  simulating  early  paresis.  He  has  observed  it  among 
men  who  have  been  subjected  to  intensive  training  in  army  training 
camps. 

These  persons  show  tremor,  iris  symptoms,  and  slurring  or  speech 
disturbances  upon  repetition  of  test  phrases — a  symptom  complex 
which  has  been  regarded  as  almost  diagnostic  of  paresis. 

Syphilis  could  be  excluded  and  after  a  few  days  of  rest  the  nervous 
system  regained  its  normal  equilibrium  with  complete  permanent 
disappearance  of  the  symptoms. 

Rest  results  in  cure. 

The  British  have  found  it  best  to  send  patients  of  this  type  to  a 
rest  cure  immediately  behind  the  battle  line.  The  results  justify 
continuance  of  this  method. 

EPILEPSY 

The  epileptic  also  may  pass  the  recruiting  officer  by  concealing  the 
truth  concerning  his  infirmity.  Frequently  epileptics  are  seen  in  the 

362 


THE   NERVOUS   SYSTEM  363 

service  and  the  character  of  their  duties  aboard  ship  necessitates  their 
prompt  discharge  from  service. 

An  epileptic  helmsman  might  endanger  the  ship  if  siezed  by  a  con- 
vulsion while  at  the  wheel. 

An  epileptic's  infirmity  might  result  in  his  own  drowning  if  he 
should  fall  overboard  during  an  attack. 

The  physical  courage  of  the  epileptic  is  proverbial.  Napoleon 
Bonaparte  was  an  epileptic.  A  noted  alienist  stated  he  would  rather 
lead  a  command  of  epileptics  into  battle  than  an  equal  number  of 
normal  men. 

"The  epileptic  does  not  know  fear." 

SHELL  SHOCK 

The  concussion  following  the  passage  or  explosion  of  a  shell  near  an 
individual  may  cause  even  death,  with  or  without  visible  injury. 

If  death  does  not  occur  one  may  see  almost  every  conceivable 
mental,  motor,  or  sensory  disturbance. 

Some  present  the  text-book  picture  of  neurasthenia,  while  others 
run  the  gamut  of  hysterical  manifestations,  or  suggest  organic  disease. 

Wilshire  remarks  the  infrequency  of  shell  shock  among  those  who 
have  received  wounds.  This  seeming  immunity  of  the  wounded  is 
thought  to  be  due  to  the  neutralization  of  the  action  of  the  psychic 
cause  of  shell  shock  by  the  wound. 

Psychic  exhaustion  as  result  of  horrible  sights,  fear,  or  continued 
anxiety  predisposes  to  shell  shock. 

Carbon  monoxide  poisoning  following  explosion  of  the  shell  has  been 
thought  to  be  a  possible  cause,  but  it  is  improbable  that  the  gases 
alone  are  responsible  for  shell  shock.  A  constitutional  inferiority  or 
psychopathic  state  is  the  basis  upon  which  shell  shock  develops. 
"Shell  shock"  or  war-strain  may  not  necessarily  be  caused  by  shell 
fire. 

Neurasthenia,  hysteria,  and  malingering  must  be  considered  in 
making  a  diagnosis.  Salmon  states:  "Neuroses  constitute  one  of  the 
most  formidable  problems  of  modern  war." 

WOUNDS 

As  result  of  trauma,  however  produced,  injury  to  the  brain  or 
nervous  system  may  result  in  impairment  of  function  varying  as  much 
in  type  and  degree  as  the  trauma  may  vary  in  character  and  intensity. 


364  NAVAL   HYGIENE 

Paralyses  resulting  from  nerve  injury  are  being  treated  by  reeduca- 
tion after  surgery  has  done  its  utmost  to  restore  function. 

Most  gratifying  results  are  being  obtained  from  this  "rehabilita- 
tion," and  members  formerly  considered  useless  now  are  made 
functionally  useful. 

PROPHYLAXIS 

Prevention  of  the  various  non-traumatic  mental  and  nervous 
conditions  occurring  in  the  naval  service  requires  recognition  of  the 
fact  that  all  of  them  depend  upon  an  original  neuropathic  or  psycho- 
pathic basis. 

The  individual  has  not  normal  mental  or  nervous  capital  from  the 
outset.  He  is  nervous,  brooding,  apprehensive,  depressed,  easily 
frightened,  or  shows  other  evidence  of  neurotic  type.  Whether  the 
condition  which  develops  be  that  of  a  functional  disorder  or  of  organic 
disease  the  history  usually  will  show  a  constitutional  inferiority  or 
psychopathic  state. 

Obviously: 

(a)  Such  persons  should  be  rejected  at  the  recruiting  stations; 

(b)  Should  be  eliminated  from  service  at  the  training  stations;  or 

(c)  Should  be  placed  in  positions  where  stress  may  not  develop 
symptoms. 

They  are  not  "first-line  men."  Their  example  may  demoralize 
others.  Their  memories  are  unreliable.  They  are  untrustworthy. 
Medical  officers  should  watch  carefully  members  of  the  crew  who  show 
any  unusual  emotional  tendency  or  other  evidence  of  psychic  abnor- 
mality. Such  should  be  weeded  out  at  earliest  opportunity.  They 
are  reeds  which  tend  to  break  when  support  is  most  needed. 

"The  trenches  is  no  place  for  a  man  with  unstable  vasomotors" 
(Osier). 


CHAPTER  XXXI 
NUTRITIONAL  DISEASES 

Scurvy. — Scurvy  formerly  caused  much  incapacity  among  the 
sea-faring  population  who  were  compelled  to  subsist  upon  salt  meats 
and  hard  tack  during  the  long  time  often  consumed  in  making  passage. 

Upon  the  discovery  that  scurvy  is  a  nutritional  disorder  and  due 
to  deficiency  in  the  diet  of  certain  constitutents  (organic  acids)  neces- 
sary to  normal  metabolism,  a  quantity  of  lime  juice  was  added  to  the 
daily  ration  and  was  found  to  be  a  valuable  prophylactic.  The  sea- 
faring population  of  today  seldom  suffers  from  this  disease. 

Fresh  meats,  vegetables,  and  fruits  supply  the  necessary  nutrients 
and  vitamines  to  prevent  development  of  the  disease  and  only  occasion- 
ally in  the  merchant  service  is  scurvy  to  be  seen.  The  ration  of 
the  Navy  has  such  a  liberal  proportion  of  anti-scorbutic  constituents 
that  we  may  say  the  disease  is  never  seen  in  the  Navy. 

Beri-beri. — -Ben-ben  is  essentially  a  polyneuritis  resulting  from 
nutritional  disorder.  It  has  been  more  or  less  prevalent  among  those 
who  are  accustomed  to  a  ration  composed  principally  of  polished  rice. 
Oriental  sailors  who  subsist  largely  upon  rice  frequently  are  attacked  by 
this  disease. 

Eijkman  demonstrated  in  1890  that  a  diet  of  polished  rice  would 
produce  polyneuritis  in  fowls,  and  Funk  isolated  from  rice  polishings 
in  1911  a  crystalline  organic  base  which  will  cure  or  prevent  polyneuritis 
in  fowls. 

The  crystalline  organic  base  was  called  a  "vitamine. "  This  base 
has  been  found  in  other  foods,  e.g.,  fruits,  vegetables,  milk,  eggs,  and 
iVv-sh  meat.  Absence  from  the  diet  of  the  necessary  quantity  of 
"vitamines"  results  in  beri-beri.  These  may  best  be  obtained  in  a 
varied  diet.  Monotonous  starchy  diet  will  produce  beri-beri,  hence 
at  >ea  a  liberal,  varied  dietary  should  be  provided. 

Reiser  and  others  have  shown  that  beri-beri  is  produced  by  eating 

polished  rice,  and  that  it  may  be  cured  by  feeding  rice  polishings 

ided  thed  cases  [have  not  advanced  too  far.     So  conclusively  has 

365 


366  NAVAL  HYGIENE 

this  been  shown  that  the  Philippine  Government  has  required  the 
general  use  of  unpolished  rice. 

Despite  the  fact  that  beri-beri  can  be  produced  by  a  prolonged 
diet  of  polished  rice  and  that  the  disease  can  be  cured  by  the  feeding 
of  the  polishings,  there  are  some  who  hold  the  theory  that  the  dis- 
ease is  due  to  a  germ  which  lives  in  rice. 

Labredo  thinks  he  has  isolated  an  organism  which  he  states  is  found  in  rice  and 
regards  as  the  cause  of  beri-beri.  His  observations  lack  confirmation,  and  in  view 
of  the  overwhelming  evidence  that  the  disease  is  a  nutritional  disorder  directly 
preventable  by  the  feeding  of  a  balanced  dietary,  the  theory  of  germ  origin  of  the 
disease  scarcely  seems  tenable. 

In  countries  where  rice  is  the  principal  article  of  food  it  should 
not  be  polished,  and  as  further  measure  of  disease  prevention,  fresh 
food  and  legumes  should  be  eaten. 

Years  ago  beri-beri  was  a  scourge  in  the  Japanese  Navy  and 
the  addition  of  appropriate  nutrients  to  the  ration  then  in  use  gave  a 
brilliant  demonstration  on  a  large  scale  of  the  favorable  results  which 
attend  proper  feeding  in  cases  which  have  not  progressed  too  far.  This 
disease  is  prevented  by  a  balanced  ration.  It  has  not  been  seen  in  the 
United  States  Navy.  Medical  officers,  however,  may  encounter  it 
among  oriental  colonials  serving  in  crews  of  navy  auxiliaries. 

At  the  siege  of  Kut-el-Amara  beri-beri  appeared  among  the  British 
troops  who  were  on  a  ration  of  white  wheaten  flour,  and  disappeared 
when  the  British  were  put  upon  the  coarsely  milled  grain  ration  of  the 
Indian  troops  cooperating  with  them. 

British  observers  conclude  that  the  germ  and  bran  should  be  in- 
cluded in  the  flour  intended  for  food. 


CHAPTER  XXXII 
HEAT  CRAMPS 

Under  certain  conditions  not  too  well  understood  the  men  in  fire 
rooms  develop  severe  cramps.  High  temperature  and  excessive  humid- 
itv  appear  to  be  predisposing  causes.  Whether  the  condition  is  the 
result  of  retention  of  catabolic  products  in  excess  of  the  body's  ability 
to  eliminate  them  or  whether  it  is  due  to  deficient  supply  of  carbohy- 
drate in  the  system  is  not  known.  Possibly  both  causes  acting  together 
produce  the  effect. 

1  have  never  observed  a  case  of  cramps  in  the  engine-room  force. 
The  engine  rooms  usually  are  hotter  and  more  humid  than  the  fire 
rooms.  The  work  of  those  in  the  engine  room  is  far  less  arduous  than 
that  of  the  coal  passers  and  firemen  who  are  working  below  in  a  dryer 
heat,  but  performing  extremely  laborious  work,  consequently  are 
oxidi/ing  more  tissue,  and  frequently  suffer  from  cramps. 

Deficiency  of  circulating  fluid  in  the  system  has  been  suggested, 
but  I  have  found  the  pulse  full  and  bounding  in  patients  just  seized 
with  cramps,  and  again  have  found  cases  in  which  there  appeared  to 
be  circulatory  depression.  The  patients  have  not  appeared  "dried 
out." 

Some  individuals  appear  predisposed  to  heat  cramps  and  develop 
tin-in  on  slight  exposure.  1  have  seen  an  instance  in  which  repeated 
attacks  occurred  in  a  young  man  who  tried  to  perform  the  duties  of  his 
nil  ing  even  after  he  was  advised  not  to  do  so  because  of  recurrence 
of  cramps  at  intervals  of  possibly  months. 

In  a  typical  case  of  heat  cramps  the  victim  may  have  slight  pre- 
monitory cramping  of  the  calf  of  the  leg,  or  possibly  of  abdominal 
muscles,  which  may  be  considered  intestinal  by  him. 

After  being  on  watch  for  some  time  an  acute  attack  comes  on  and 
m;.y  he  limited  to  one  group  of  muscles  or  to  an  extremity  provided 
the  man  slops  work  at  once,  but  if  he  continues  to  work  general  cramp- 
ing of  the  muscles  of  the  extremities,  back,  abdomen  and  neck  will 
become  most  digressing. 

67 


368  NAVAL  HYGIENE 

These  cramps  are  more  or  less  tonic  in  character  and  muscles  may 
be  drawn  into  hard  tense  masses.  In  occasional  instances  the  patients 
are  unconscious.  This  is  rare.  The  individual  seized  with  cramps 
in  the  fire  room  usually  is  carried  to  the  sick  bay,  writhing  in  ex- 
cruciating pain. 

My  experience  indicates  that  the  temperature  is  subnormal  although 
it  appears  normal.  One  who  has  stood  the  major  portion. of  a  watch 
passing  coal,  or  before  the  fires,  usually  will  be  found  to  have  a  physio- 
logical temperature  varying  up  to  102.5 °F.  as  result  of  his  arduous  labor 
and  exposure  to  heat.  When  seized  with  heat  cramps  or  heat  prostra- 
tion, even  though  the  mouth  temperature  is  shown  to  be  98.4^.,  this 
temperature,  normal  for  individuals  at  rest,  is  subnormal  for  those 
who  have  been  exposed  to  the  conditions  above  mentioned.  The  pulse 
usually  is  weak  and  rapid,  running  from  1 20  to  140.  One  case  observed 
by  me  showed  a  very  weak  pulse  of  72.  Respiration  is  about  normal, 
except  as  modified  by  the  convulsive  efforts  caused  by  the  cramping. 
Patients  usually  are  conscious  and  perspiring.  Constipation  has  not 
appeared  to  be  a  factor. 

The  urine  commonly  is  scanty  and  high-colored.  Its  specific 
gravity  has  been  found  by  me  as  high  as  1034  and  reaction  acid.  In 
every  case  albumin  is  present.  Sugar  is  absent. 

Microscopic  examination  of  the  sediment  shows  evidence  of  acute 
irritation  of  the  kidneys. 

The  Blood. — As  result  of  loss  of  body  fluids  the  haemoglobin  as  meas- 
ured by  the  Talquist  scale  appears  to  be  about  100  per  cent.,  red  cells 
from  five  to  six  million,  white  cells  about  normal. 

Nothing  remarkable  was  shown  by  the  differential  count. 

In  some  cases  vomiting  appears  and  this  has  seemed  explosive  in 
character,  suggesting  cerebral  irritation. 

Heat  cramps  are  said  to  be  more  common  on  destroyers  under  forced 
draft  than  in  battleships.  Under  these  conditions  the  air  pressure 
equals  5  inches  water  gauge;  in  the  battleships,  2  inches. 

The  following  notes  illustrate  what  may  be  met  at  any  moment 
among  the  fire-room  force  of  a  dreadnaught  battleship : 

Case  i. — At  sea.  Dry  bulb  69°;  wet  bulb  68°  (on  deck).  Barometer  30.29. 
Fireman,  2  cl.,  age  twenty,  born  U.  S.;  father  English  and  mother  German;  previous 
occupation,  teamster;  had  measles  in  childhood;  has  been  two  years  in  Navy;  has 
been  fireman,  ten  months;  has  had  two  previous  attacks  of  heat  cramps — once 
en  route  from  Guantanamo  to  Colon,  the  other  on  Southern  Drill  Grounds — both 


urn 


HEAT   CRAMPS  369 


under  forced  draft;  ate  full  noon  meal  before  going  on  watch;  urinated  last  before 
attack  at  12  :  10  p.m.;  bowels  moved  last  before  attack  eighteen  hours  previously; 
drank  five  cups  (about  1500  c.c.)  of  water  during  the  12-4  watch;  sweated  freely 
during  watch;  was  under  natural  draft  (ventilator)  during  first  two  hours  and  forced 
draft  last  two  hours  of  watch;  has  had  good  health  immediately  preceding  the  attack. 

Altai -k—  Carried  into  sick  bay  suffering  with  violent  cramps  especially  in  muscles 
(extensor  groups)  of  extremities  and  abdomen.  Contractions  appeared  almost 
w -lolly  confined  to  extensors — clonic  spasms  lasted  two  to  three  minutes. 

ipi-rature  (by  mouth)  98.2°*'.;  pulse  135,  weak;  skin  cool  and  drenched  with 
sveat;  respiration  normal.  No  headache,  nausea,  vertigo,  vomiting  or  involuntary 
action  of  sphincters.  Pupils  react  normally.  Reflexes  normal.  Patient  conscious. 
Slight  cyanosis  of  skin.  Possibly  heart  was  enlarged  slightly.  Urine:  about  200 
c.c.  of  highly  albuminous  urine  (T.  98.2°?.)  passed  about  four  hours  after  attack. 
Analysis  not  completed  because  of  darkness  in  darkened  ship  in  battle  practice. 

Patient  was  placed  in  warm  bath  and  given  10  minims  of  Tr.  belladonnas.  Mas- 
saged. Free  ingestion  of  fluids  urged.  Within  forty-eight  hours  patient  returned 
to  duty. 

Case  2. — At  sea.  Dry  bulb  72°;  wet  bulb  71°;  barometer  30.04  (on  deck). 
Fireman,  i  cl.;  age  twenty-five;  nat.  U.  S.;  both  parents  Irish;  "never  in  bed  a  day 
in  my  life;  "  served  nearly  three  years  as  coal  passer  and  fireman;  bowels  moved  freely 
7  :  30  a.m.;  urinated  last  about  forty-five  minutes  before  attack;  had  8-12  :  oo  p.m. 
watch  on  August  22  and  felt  O.  K.  when  went  on  watch  at  8  :  30  a.m.,  August  23. 
D'ank  no  water  on  watch  before  attack.  ("It  gives  cramps  more  than  anything 
eb.e  to  drink  cold  water  when  on  the  fires,"  he  says.)  Blowers  at  full  speed  series, 
fo-ced  draft. 

Attack. — Violent  cramping  in  abdominal  muscles,  shoulders,  back  of  neck,  and 
extremities,  especially  in  extensors  of  back  and  calves  of  legs. 

Temperature  98.4;  pulse  weak  and  72;  respiration  normal;  heart  normal;  reflexes 
normal;  perspiring  freely.  Heart  area  not  enlarged.  Seized  about  10  :  oo  a.m. 
Temperature  in  fire  room  119°  dry  bulb. 

At  12  145  p.m.  he  passed  200  c.c.  of  highly  albuminous  urine,  and  only  500  c.c. 
during  first  twenty-four  hours  after  watch.  Urine  neutral,  sp.  grav.  1034;  no  sugar, 
much  albumin;  many  hyaline  casts;  few  blood  cells;  and  epithelium. 

Case  3. — At  sea.     Wet  bulb  72°;  dry  bulb  72°;  barometer  30.03.     Coal  passer, 

age  twenty-two;  nat.  U.  S.;  parents  U.  S.;  ha-  been  in    Navy  one  year  as  coal 

passer,  except    three  months  as   fireman.     Had  8-12  midnight   watch.     Ate  full 

br-akfa-t  and  went  on  watt  h  at  S  :  oo  a.m.     Last  defecated  8  :oop.m.  evening  before 

•  .     Last  urinated  three  hours  before-  attack. 

Has    had   mca>lcs,  chicken  ]>ox,  and   mumps.      \\  4  coal   when    seized. 

Me  to  walk  to  sick  bay.  \\  a-  di/./.y,  pair,  faint,  per-piring,  pulse  140  and 
wiak.  Temperature  normal.  Respiration  normal.  Severe  cramping  in  lit  \ors 
left  thigh,  and  e.v 

Passed  no  urine  until  6:00  p.m. 

Urine — neutral  reaction.  1026;  no  sugar;  albumin  in  abundance,  ppt. 

**  16%  per  cent.  vol.  of  tube;  no  blood,  epithelium  present.  Total  quantity  for 
twenty-four  hours  450  c.c. 

24 


37°  NAVAL  HYGIENE 

Case  4. — At  sea.  Dry  bulb  76°;  wet  bulb  75°;  barometer  30.23  at  4:00  p.m. 
Had  12-4:00  p.m.  watch.  Had  cool  to  tepid  bath  coming  off  watch.  Cramps  came 
on  in  flexors  of  extremities  and  later  in  abdomen  and  cervical  muscles.  Came  for 
treatment  two  hours  after  coming  off  watch.  Reflexes  normal,  but  the  eliciting  of 
the  patellar  reflex  causes  a  violent  cramping  in  adductors  of  thigh  of  leg  under  exami- 
nation. Possibly  this  was  coincidental,  but  it  is  believed  that  the  striking  of  the 
patellar  tendon  caused  the  cramping,  as  it  appeared  after  each  blow. 

Temperature  99.4;  pulse  weak  and  soft,  120;  respiration  18.  Great  prostration 
and  weakness.  Free  perspiration.  No  urine  passed  from  6  :  oo  p.m.  to  9  :  oo  a.m. 
when  125  c.c.  were  voided. 

Urine — somewhat  smoky;  sp.  grav.  1029;  reaction,  faintly  acid;  albumin,  very 
heavy  trace; sugar, none.  Numerous  hyaline  casts, some  with  epithelium  attached, 
urates,  few  calcium  oxalate  crystals  and  blood  cells  (few  red  cells)  and  some  renal 
epithelium. 

Case  5. — At  sea.  Wet  bulb  69°;  dry  bulb  68°;  barometer  30.03.  Fireman,  2  cl.; 
age  twenty-two;  nat.  Iowa;  both  parents  German;  patient  has  had  gonorrhea  and 
tonsilitis. 

Went  on  watch  8  :  oo  a.m.  and  came  off  at  12  :oo  m.  Ate  full  breakfast  and 
dinner.  Last  evacuation  twenty-four  hours  before  attack.  Last  urination  one 
hour  before  going  on  watch  8  :  oo  a.m.  Did  not  urinate  during  watch.  Sweated 
profusely.  Drank  abundance  of  moderately  cold  water.  Cramps  came  on  while 
washing  up  after  watch  (not  severe)  but  three  hours  later  became  so  bad  as  to 
cause  patient  to  apply  for  treatment.  Temperature  98.4°;  respiration  24;  pulse 
82  (three  hours  after  watch). 

Patient  worked  under  forced  draft,  blowers  at  full  speed. 

Passed  small  amount  of  urine. 

Urine — reaction,  acid;  sp.  grav.  1020;  albumin,  large  amount;  sugar,  negative. 
Hyaline  casts  and  epithelium. 

An  engineer  officer  who  served  on  the  U.  S.  S.  Minnesota  states 
that  the  members  of  the  fire-room  force  appear  far  less  susceptible  to 
heat  cramps  after  eating  canned  tomatoes  or  canned  fruit,  especially 
canned  peaches.  My  own  observations  indicate  that  increase  of  carbo- 
hydrate in  the  shape  of  sugar  saves  tissue  oxidation,  and  tends  to 
prevent  heat  cramps. 

The  following  is  quoted  from  a  report  made  by  me  concerning  an 
endurance  run  of  a  first-class  battleship  during  November,  1915.  The 
men  were  examined  physically  before  the  trial  was  commenced  and 
after  the  trial  was  completed.  It  should  be  borne  in  mind  that  during 
an  endurance  run  the  maximum  possible  speed  is  got  out  of  the  engines 
during  the  run.  This  full  power  run  always  taxes  the  personnel  of  the 
engine  and  fire  rooms,  and  those  having  tendency  to  heat  cramps  are 
apt  to  develop  them: 


I  HE  AT   CRAMPS  371 

REPORT  OF  FULL  POWER  RUN 
(a)  Physical  condition  of  personnel  before  trial  was  excellent. 
(6)  During  trial  physical  condition  appeared  excellent. 

(c)  No  cramps  or  after-effects  of  consequence  were  observed. 

(d)  All  men  observed  appeared  to  be  physically  qualified  for  the  arduous  duty 
being  performed. 

(e)  Water  from  scuttle-butt  at  temperature  of  about  S5°F.  was  the  only  fluid 
known  to  have  been  used  for  drinking.     Bucket  for  fresh  water  bath  and  salt  shower 
co  istituted  type  of  bath  used. 

Ventilation  appeared  to  be  adequate  under  conditions  in  which  full  power  run 
\v;i>  made.  Thermometer  on  deck  registered  dry  bulb  5o°F.,  wet  bulb  So°F.,  averag- 
ing this  during  the  watch. 

The  following  thermometric  observations  were  taken  during  the  full  power  run 
(about  ii  :  30  p.m.)  the  run  being  from  8  :  23  p.m.  to  12  :  23  a.m.: 

Dry  bulb  Wet  bulb 

Steering  engine  compartment 106°  77-5° 

Engine-room  platform 101°  76.0° 

Fire  room  No.  i 98°  68 . 5° 

Fire  room  No.  2 92°  68.0° 

Fire  room  No.  3 88°  64 . 5° 

Above  temperatures  indicate  very  favorable  working  conditions,  especially  as  to 
hu:nidity.  No  special  contamination  of  air  was  noted  except  the  coal  dust  in  fire 
rocms  and  oil  odor  in  engine-room  spaces. 

Special  observations  were  made  upon  the  men,  fire  rooms  i  and  2. 

Sugar  ("domino")  was  given  ad  libitum  to  the  eighteen  (18)  men  in  fire  room 
\«>.  i,  while  no  sugar  was  given  to  the  same  number  of  men  under  same  conditions 
in  fire  room  No.  2. 

Following  comparisons  are  made  for  what  they  are  worth.  Inability  properly 
to  conduct  the  experiment  without  interference  with  the  paramount  issue,  viz., 
keeping  up  steam,  causes  the  data  here  given  to  be  less  valuable  than  it  might  have 
been.  Data  relative  to  weight  are  closely  approximate  while  those  relative  to  pulse 
and  temperature  are  accurate  (temperature  by  mouth). 

Weight  average,  not  stripped,  but  in  clothes: 

Before  run  After  run 

Fire  room  No.  i.  .  154-9  I53-° 

Fire  roon  160.3  ISS-° 

Temperature  averi. 

Fire  room  No.  i.  98.4  98.3 

I  ire  room  No.  2.  .  o,S .o  97.4 

Pulse  average: 

Fire  room  \o.  i.  .  81.5  98.5 

Fire  room  \o.  2. .  80.9  102.7 


372  NAVAL   HYGIENE 

Urine  in  23  specimens  showed: 

Negative  albumin 14 

Slight  trace 7 

Trace i 

Heavy  trace i 

23 

Comparison  of  urinalyses  shows  negligible  difference  between  the  men  using  sugar 
and  those  who  were  not  given  sugar. 

Subject  to  foregoing  remarks  concerning  accuracy  of  data  it  is  noted  that  the 
following  average  loss  in  weight  occurred: 

Fire  room  No.  i 1.9  pounds. 

Fire  room  No.  2 5 . 3  pounds. 

Temperature  observations  indicated  no  marked  variations.     It  is  believed  that 
observations  of  rectal  temperature  would  have  shown  different  results. 
Pulse: 

Before  run  After  run 

Fire  room  No.  i 81.5  98 . 5 

Fire  room  No.  2 80 . 9  102 . 7 

The  men  of  fire  room  No.  i  showed  an  increase  of  17  beats  per  minute,  while 
those  of  fire  room  No.  2  showed  an  increase  of  21.8  beats,  a  difference  of  4.8  beats. 
In  other  words  the  hearts  of  the  18  men  to  whom  sugar  was  given  performed  20.8 
per  cent,  additional  work  during  the  watch;  while  the  hearts  of  the  18  men  who 
received  no  sugar  (other  than  ration  served  to  both  groups)  performed  26.9  per  cent, 
additional  work  during  the  watch — or  6.1  per  cent,  more  than  the  sugar-fed  group. 
But  when  the  percentage  of  additional  work  is  considered: 

Group  No.  i - 17.0   beats    per   minute 

Group  No.  2 ...21.8    beats   per   minute 

Difference 4.8    beats    per    minute. 

represents  about  28  per  cent,  of  the  additional  work  performed  by  the  sugar-fed 
group.  The  hearts  of  group  No.  i  did  28  per  cent,  less  additional  work  than  group 
No.  2.  With  full  appreciation  of  the  unavoidable  crudeness  of  the  experiment 
and  of  the  inaccuracy  of  some  of  the  data  above  given  it  would  appear  that  the 
sugar-fed  group  suffered  less  exhaustion  during  their  arduous  work.  Was  sugar 
responsible  wholly,  or  in  part  for  lessening  the  work  of  the  hearts  of  group  No.  i? 
It  is  believed  it  played  a  considerable  part,  and  that  further  better  controlled 
observations  may  be  worth  while. 

Prophylaxis. — Men  having  kidney  lesions  should  not  be  permitted 
to  pass  coal  or  to  fire.  Unseasoned  men  should  not  be  put  on  fires  in 
hot  weather  if  it  can  be  avoided.  Heat  prostration  is  more  apt  to 
occur  when  the  reading  of  the  dry  and  wet  bulb  thermometers  are 


IIK.XT    CRAMPS 


373 


about  the  same.  I  have  seen  cases  occur  when  the  wet  bulb  thermom- 
eter on  deck  read  68°,  69°,  71°,  72°  and  75°  respectively.  The  fire- 
room  temperatures  were  not  excessive  at  these  times.  The  experienced 
fireman  knows  that  the  drinking  of  cold  water  tends  to  precipitate 
hi-at  cramps,  and  it  is  not  uncommon  for  the  cramping  to  occur  after  a 
man  has  been  away  from  the  fires  several  hours.  Men  of  experience 
in  the  fire  room  will  not  drink  cold  water.  Many  prefer  barley  water 
which  they  make  lukewarm.  Some  experienced  firemen  attribute 
cramps  to  sudden  chilling,  e.g.,  standing  under  forced-draft  blowers. 
This  should  be  avoided.  Increase  of  carbohydrate  as  sugar  or  glucose 
in  diet  should  be  tried  by  those  subject  to  heat  cramps. 

Treatment. — Immerse  patient  in  hot  bath  at  once,  administer  atro- 
phe  or  belladonna,  give  cool,  not  cold,  fluids  by  mouth.  If  necessary 
morphia  may  be  given  for  relief  of  pain.  In  extreme  cases  intravenous 
injection  of  0.6  per  cent,  salt  solution  (i.e.,  below  normal  strength)  may 
be  necessary,  as  may  the  administration  of  glucose  solution. 


CHAPTER  XXXIII 
SPUTUM-BORNE  DISEASES 

The  communicable  diseases  which  are  transmitted  through  the 
sputum  have  received  too  little  attention  from  the  profession  at  large. 
A  moment's  reflection  brings  the  realization  that  tuberculosis,  syphilis, 
and  many  other  diseases  of  lesser  importance  are  transmitted  by  this 
medium,  and  that  the  proper  control  of  oral  and  nasal  secretions  will 
greatly  reduce  the  morbidity  and  mortality  from  these  diseases.  The 
secret  of  prophylaxis  lies  in  the  complete  disinfection  of  the  sputum. 
This  disinfection  or  destruction  should  be  done  uncompromisingly, 
for  the  single  expectoration  of  a  tuberculous  or  pneumonia  patient 
is  a  potential  source  of  infection  for  a  number  of  susceptible  individuals. 

The  disinfection  of  the  sputum  may  be  accomplished  by: 

(a)  Physical  means; 

(b)  Chemical  means. 

(a)  The  physical  means  may  be: 

1.  Burning; 

2.  Boiling; 

3.  Burying. 

(a)  Physical  Means. — i.  Burning. — When  the  sputa  are  received 
in  paper  sputum  cups,  or  in  paper  handkerchiefs,  or  in  the  sawdust 
which  is  occasionally  provided  for  the  purpose,  destruction  by  fire  is  by 
far  the  best  method  of  disposing  of  the  infectious  material. 

Nurses  or  others  engaged  in  handling  the  sputa  should  be  especially 
cautioned  of  the  danger  and  should  disinfect  their  hands  after  each 
handling  of  sputum. 

2.  Boiling. — Incombustible    sputum    cups   or    containers  or  other 
incombustible  articles  which  will  not  be  injured  by  boiling  may  be 
boiled  for  twenty  to  thirty  minutes  and  their  sterilization  effected. 
This  method  of  disinfection  should  be  employed  in  the  sterilization 
of  linen  soiled  by  sputa. 

3.  Burial. — It  is  conceivable  that  occasion  may  arise  when  neither 
of  the  foregoing  methods  is  practicable  and  burial  must  be  resorted 

374 


SPUTUM-BORNE   DISEASES  375 


This  method  of  disposition  is  extremely  undesirable  and  unsatis- 
factory if  necessary  at  times. 

If  in  the  field  it  becomes  necessary  to  dispose  of  sputum  by  burial, 
the  depth  of  the  pit  used  should  not  be  sufficiently  great  to  reach  the 
ground  water  level,  as  this  might  result  in  infection  of  nearby  wells  or 
springs.  The  discharges  should  be  covered  with  chlorinated  lime 
before  the  pit  is  filled  with  earth. 

(b)  Chemical  Means. — The  chemical  disinfection  of  sputum  may 
be  accomplished  by  the  addition  of  crude  carbolic  acid,  2  per  cent. 
Bichloride  of  mercury  solution  should  not  be  used  because  it  forms  an 
a  buminate  of  mercury  which  envelopes  the  viscid  sputum  mass,  but 
fa.ils  to  penetrate  to  its  interior,  consequently  it  fails  to  kill  the 
organisms  which  are  incorporated  in  the  sputum. 

In  addition  to  the  destruction  of  sputum  a  campaign  of  popular 
education  concerning  the  dangers  of  sputum-borne  diseases  should 
he  begun  early  in  life.  The  writer  is  of  opinion  that  instruction  con- 
cerning sputum-borne  and  other  communicable  diseases  should  be  a 
part  of  the  curriculum  of  the  grammar  schools  of  the  country.  It  is 
better  that  the  youth  of  the  country  be  rugged  and  strong  even  at  the 
expense  of  what  we  are  today  pleased  to  call  "education." 

The  dangers  attendant  upon  coughing  and  sneezing  should  be 
taught  and  the  covering  of  the  nose  and  mouth  with  the  handkerchief 
sfould  be  thoroughly  impressed,  together  with  the  fact  that  persons 
apparently  healthy  may  by  coughing  or  sneezing  transmit  a  fatal 
pneumonia,  cerebro-spinal  meningitis,  tuberculosis  or  other  com- 
municable disease  to  susceptible  individuals. 

The  use  of  paper  handkerchiefs  should  be  encouraged,  and  their 
manufacture  should  be  so  cheapened,  as  in  Japan,  that  they  will  replace 
the  less  sanitary  cotton,  linen  and  silk  handkerchiefs  which  are  not 
sterilized  nearly  so  frequently  as  they  should  be.  The  paper  hand- 
kerchiefs should  be  burned  after  use. 

The  anti-spitting  laws  should  he  carefully  enforced,  as  should  be  the 
safe  and  sanitary  method  of  covering  the  nose  and  mouth  in  sneezing 
and  couching. 

Persons  affected  with  sputum-borne  diseases  should  be  made  to 
reili/e  that  they  are  a  danger  to  the  community  and  they  should  be 
impressed  with  the  obligation  incumbent  upon  them  to  do  their 
share  in  preventing  the  spread  of  their  diseases. 

Sputum  should  be  received  in  covered  cups  to  prevent  access  of 


376  NAVAL  HYGIENE 

flies,  roaches,  or  other  insects  which  may  travel  from  the  sputum  cup 
to  prepared  food,  carrying  disease  as  they  go. 

Likewise  domestic  animals,  such  as  cats  and  dogs,  may  nose  around 
an  uncovered  sputum  cup  getting  their  muzzles  soiled  and  so  conveying 
infection  to  persons  petting  the  animals. 

The  sputum-borne  diseases  may  be  classified  into  those  due  to: 

1.  Bacilli; 

2.  Cocci; 

3.  Spirochsete; 

4.  Flukes; 

5.  Those  of  unknown  cause. 

1.  The  bacillary  sputum-borne  diseases  are  pneumonia,  tuberculosis, 
typhoid  fever,  cholera,  plague,  bacillary  dysentery,  diphtheria,  Vincent's 
angina,  whooping  cough. 

2.  Cocci. — Streptococci — several   forms    of   tonsilitis;   diplococci — 
cerebro-spinal  meningitis. 

3.  Spirochate. — Syphilis,  Vincent's   angina,  and   Spirochcete  ictero- 
hemorrhagica  (?). 

4.  Those   due   to  flukes — lung  fluke  or  Paragonimus  westermanii 
and  Fasciola  gigantea  (both  rare). 

5.  Those   due  to  unknown  causes — measles,  chicken-pox,  German 
measles,  scarlet  fever,  yellow  fever,  mumps. 

Sputum  should  be  recognized  as  a  more  common  source  of  disease 
than  urine,  and  its  disposal  should  receive  more  consideration  than  is 
accorded  to  the  less  dangerous  urine. 

Improper  disposal  of  sputum  aids  in  the  spread  of  diseases  and  pus 
infections.  The  working  of  the  present  method  of  sputum  disposal 
is  far  from  possible  attainment. 

The  galvanized  iron  cuspidors  now  in  use  have  a  diameter  of  10 
inches  at  the  top,  9  inches  at  the  bottom,  and  an  inside  depth  of  5^ 
inches.  These  cuspidors  partly  filled  with  water  are  placed  at  con- 
venient points  in  the  living  spaces.  They  are  easily  moved  about, 
their  contents  being  slopped  over  as  they  are  stumbled  against  by  a 
careless  skylarker  or  sweeper.  Too  frequently  the  cuspidor  is  spat 
at  rather  than  into. 

At  a  recent  captain's  inspection  thirteen  out  of  fourteen  spit  kids  showed  evi- 
dence of  fresh  or  dried  sputum  upon  the  outside  or  upon  the  deck  in  the  immediate 
vicinage.  It  must  be  admitted  that  in  some  cases  the  sputum  lay  not  as  it  fell  on 


SPUTUM-BORNE    DISEASES 


377 


deck,  but  was  smeared  out  into  a  comet  shape  by  a  watchful  swab.  The  excep- 
tion (counted  for  loyalty  to  fact)  was  placed  behind  some  mess  tables  where  con- 
veniently it  could  not  be  spat  at. 

As  cuspidors  of  the  type  now  furnished  are  mobile  they  merely 
multiply  foci  of  deck  infection,  the  particles  of  inspissated  sputum 
floating  in  the  dust-laden  air  of  compartments  which  are  the  sites  of 
such  varied  activities,  and  the  domiciles  of  so  many  who  may  be  sus- 
ceptible to  infection.  Since  expectoration  aboard  ship  is  recognized 

supplying  cuspidors,  it  seems  desirable  properly  to  provide  for 


Fn..    i.<<>.  : -urinal  suggested  by  the  writer.     It  should  have  a  some- 

•at  larger  b<>\vl  than  the  urinal  in  common  use  and  should  be  flushed  constantly 
by  salt-water  in  sin  h  manner  that  its  entire  inner  surface  is  bathed  with  the  moving 
salt  water.  This  cuspidor-urinal  should  be  fixed  on  the  bulkhead  and  would  be 
nearer  to  the  source  of  the  sputum. 

disposal  of  sputum.     For  sanitary  reasons  and  because  of  offense  to 
our  aesthetu  re  provide  at  convenient  places  on  board  ship, 

self-flushing  urinals  for  disposal  of  urine  in  a  prompt  and  sanitary 
manner.     No  such  provi>ion   is  made  for  removal  of  sputum  despite 

tlu-  fart  that  more  di-ea>e  i>  -pread  by  sputum  than  urine. 

Yi-rid,  dangerous  sputum  is  expectorated  at  long  range  toward  a 
small  mobile  cuspidor  while  the  le-<  dangerou^  urine  i-  voided  into  a 
flushed  urinal,  offering  a  larger  target,  at  Gorier  range,  and  with  better 
facilities^ for  aiming. 


NAVAL   HYGIENE 

Perhaps  it  is  Utopian  to  hope  for  flushing  cuspidors  properly 
located  aboard  ship  at  this  time,  but  it  is  believed  that  it  is  feasible 
and  desirable  to  place  upon  brackets  on  the  bulkheads  removable 
cuspidors  15  inches  in  diameter  and  8  inches  deep,  the  mouths  of  the 
cuspidors  to  be  40  inches  above  the  deck.  The  cuspidors  should  be 
provided  with  steel  straps  which  could  be  made  a  part  of  the  suspending 
apparatus  and  serve  as  a  handle  when  cleaning  is  done,  thus  avoiding 
the  danger  incident  upon  handling  the  cuspidors.  Such  a  cuspidor 
would  possess  the  advantage  of  being  40  inches  nearer  the  source  of 
sputum,  would  have  a  larger  mouth,  and  its  location  on  the  bulkhead 
would  necessitate  approaching  the  cuspidor  in  order  to  use  it.  The 
location  on  a  white  vertical  bulkhead  would  render  improbable  the 
careless  use  or  kicking  over  of  the  receptacle.  Properly  constructed 
and  located  cuspidor-urinals  about  40  inches  high  are  desiderata, 
and  should  be  provided  as  are  urinals  today. 

The  cuspidors  now  in  use  aboard  ship  should  be  boiled  or  steamed 
daily  during  the  morning  watch. 


CHAPTER  XXXIV 


INFECTIOUS   DISEASES 

When  armies  are  in  the  field  at  work  their  morbidity  rate  is  lowest. 
It  increases  with  the  idleness  which  results  from  prolonged  stay 
i  garrison  and  camp. 

So  with  the  naval  personnel.     Their  morbidity  rate  increases  when 
icy  arrive  in  port,  and  are  exposed  to  the  various  disease-producing 
luences  not  usually  found  aboard  ship,  e.g.,  foci  of  infection,  drink, 
ind  prostitution. 

Idleness  and  sickness  go  hand  in  hand. 

To  fight  intelligently  an  infectious  disease  requires: 

i .  A  knowledge  of  the  cause. 

An  understanding  of  its  mode  of  transmission. 
Isolation  of  the  sick. 

Prevention  of  the  scattering  of  contacts  and  suspects. 
Proceeding    against    the    causative    organism    and   against    its 
itermediate  hosts. 

6.  Disinfection  of  excreta,  clothing,  etc. 

7.  Disinfection  of  the  patient.     He  is  more  dangerous  than  the 

8.  Treatment  or  isolation  of  carriers. 

VENEREAL  DISEASES 

\  mereal  diseases  probably  are  responsible  for  more  suffering, 
:conomi<  lo-s,  and  impairment  of  efficiency  in  the  naval  service  than 
any  other  class  of  diseases  a  flirting  its  personnel.  Figures  are  not 
yet  a\ailal)le  for  the  e\j>re»ion  of  damage  done  during  this  war.  But 
h  recent  years,  in  time  of  peace,  enough  men  have  been  on  the  sick 
onstantly  to  make  the  damage  to  the  naval  service  equivalent  to 
j.huing  one  dreadnaught  battleship  out  of  commission  for  every  day 
during  the  entire  year. 

The  Surgeon  General's  office  shows  the  following  average  of  the 

379 


380  NAVAL  HYGIENE 

annual  admission  rates  per  1000  for  the  decade  ending  January  i, 
1917,  viz.,  chancroid,  29;  gonorrhea,  82.81;  syphilis,  22.14 

Venereal  diseases,  i.e.,  gonorrhea,  syphilis,  and  chancroid,  have 
cost  inestimable  suffering  to  the  personnel  of  the  Navy,  and  any  effort 
to  improve  conditions  should  meet  with  hearty  cooperation  on  the  part 
of  the  administrative  authorities. 

So  long  as  men  are  men,  and  women  are  women,  the  natural  instinct 
for  preservation  of  kind,  an  instinct  second  in  power  only  to  self- 
preservation,  will  find  its  manifestation.  Society  in  our  country  has 
been  prone  to  condemn  frank  discussion  of  this  subject  and  the  topic 
has  been  hedged  about  with  a  secrecy  which  has  done  much  to  further 
the  cause  of  evil  and  prevent  the  competent,  intelligent  control  over  a 
condition  which  has  forced  recognition.  Until  society  has  attained  a 
moral  plane  far  above  that  upon  which  it  now  stands,  illicit  sexual 
congress  will  continue,  and  venereal  diseases  will  be  disseminated. 

It  seems  wise  to  recognize  the  existence  of  conditions,  to  take 
a  masterful  grip  of  a  bad  situation  and  control  it.  Not  a  little  moral 
guilt  is  attached  to  those  who,  closing  their  eyes,  imagine  that  by  so 
doing  they  are  preventing  existence  of  the  social  evil  and  its  trail  of 
disease  and  suffering. 

Mothers  and  fathers  are  remiss  in  a  sacred  duty  when  they  fail  to 
instruct  concerning  the  care  and  function  of  the  reproductive  organs 
and  the  inevitable  dangers  which  lurk  in  the  pathway  of  the  young  men 
and  young  women  who  go  into  the  world  without  a  proper  knowledge 
of  the  dangers  of  violating  natural  laws  in  respect  of  exercise  of  the 
generative  function. 

The  above-mentioned  prevalence  of  venereal  diseases  in  the  naval 
service  is  not  to  be  construed  as  an  implication  that  the  personnel  of 
the  naval  service  is  worse  with  the  respect  of  sexual  morality  than  a 
corresponding  number  of  men  of  the  same  ages  and  walks  in  life.  The 
most  accurate  statistics  concerning  the  movement  of  venereal  diseases 
among  males  are  the  statistics  compiled  for  years  past  by  the  Army 
and  Navy.  The  men  in  the  naval  and  military  service  undergo  a 
careful  physical  examination  upon  enlistment;  are  under  constant 
medical  supervision,  and,  with  the  exception  of  a  few  cases  which  are 
concealed,  accurate  records  are  kept  because  of  the  bearing  of  venereal 
diseases  and  incapacity  resulting  therefrom  upon  probable  future  pen- 
sion claims.  Nowhere  else  in  the  country  are  kept  such  accu-ate 
statistics  concerning  these  diseases.  Recently  some  states  have  made 


INFECTIOUS   DISEASES  381 


venereal  disease  notifiable,  but  even  here  the  self-treatment,  and  the 
treatment  suggested  by  the  cupidity  and  ignorance  of  a  drug  clerk, 
do  much  toward  vitiating  statistics  which,  from  other  points  of  view, 
are  not  too  dependable.  The  young  men  of  the  Navy  are  drawn  from 
civil  life  and  return  to  civil  life  when  they  leave  the  Navy.  They  cannot 
h  gonorrhea  from  a  thirteen-inch  gun  or  syphilis  from  the  per- 
formance of  routine  duties.  In  order  to  acquire  venereal  diseases  they 
must  return  to  the  civil  life  whence  they  have  come  and  where  vicious 
\\omen  give  disease  in  exchange  for  money. 

R    Enlisted  men  of  the  Navy  suffering  with  venereal  diseases  in  an 
ifectious  stage  are  not   granted  shore  leave.     It  is  regretted  that 
civil  communities  do  not  similarly  quarantine  their  venereal  cases. 

Just  here  it  may  be  noted  that  prostitutes  are  probably  the  most 
insidious  and  dangerous  of  spies.     They  ply   their  nefarious   trade 
for  the  purpose  of  obtaining  information  from  their  partners  in  crime 
communicate  it  to  the  enemy  who  has  sent  them  out.     Infected 
omen  may  be  employed  by  the  enemy  to  infect  opposing  forces. 
One  infected  woman  may  spread  disease  to  so  many  as   25  men 
a  single  night.     While  in  Alaska  the  writer  was  told  of  a  prostitute 
ho  limited  her  favors  to  periods  of  twenty  minutes  and  actually  sold 

s  for  a  definite  time  and  guaranteed  their  turn  to  purchasers. 
The  prevention  of  venereal  diseases  in  the  Navy  is  a  difficult  problem 
and  may  best  be  met  by:  first,  education;  second,  occupation;  third, 
diversion;  fourth,  abstinence  from  alcohol;  fifth,  prophylaxis. 

i.  Education. — The  education  of  the  individual  should  begin  early 
in  life.  Usually  instruction  has  not  been  given  until  after  men  are  in 
the  Navy  and  have  learned  much  that  is  false  concerning  sex  hygiene. 
The  medical  officers  should  instruct  officers  and  men,  in  groups  of 
convenient  size,  concerning  the  prevalence,  mode  of  infection,  preven- 
tion, complications  and  dangers  caused  by  these  diseases.  Such 
instructions  should  be  thorough  and  should  be  repeated  sufficiently 
often  and  simply  to  insure  that  there  is  a  general  understanding  con- 
cerning the  various  phases  of  the  diseases  mentioned.  It  is  not  con- 
sidered that  the  clinical  aspects  of  the  diseases  or  the  treatment  should 
be  given,  but  rather  that  the  great  damage  inflicted  and  methods  of 
avoidance  of  the  diseases  should  be  taught. 

The  very  common  belief  that  virility  will  be  lost  unless  there  is 
indulgence  in  sexual  intercourse  should  be  strongly  combated,  and  men 
should  be  taught  that  they  will  be  stronger,  healthier  men  and  better 


382  NAVAL  HYGIENE 

fitted  for  paternity  if  they  are  continent  until  such  time  as  they  desire 
to  leave  children  to  inherit  their  names.  Seminal  emissions  usually 
indicate  sexual  strength.  Men  should  be  taught  this  in  lecture  and  in 
leaflet. 

2.  Occupation. — Idleness  is  a  breeder  of  vice  and  vicious  habits. 
Work  should  be  so  arranged  as  to  keep  men  employed  and  to  produce 
physical  fatigue  which  will  tend  to  lessen  sexual  desire.     Occupation 
will  crowd  out  thoughts  and  suggestions  of  libidinous  character. 

3.  Diversion. — For  the  same  reason  that  occupation  is  desirable, 
diversion  and  amusement  should  be  provided  for  men  during  their 
resting  hours.     Reading,  games,  athletic  contests,  amateur  theatricals, 
moving  pictures,  all  are  useful. 

4.  Abstinence  from  Alcoholic  Drink. — Alcohol  is  responsible  for  a 
large  amount  of  venereal  disease.     It  tends  to  inflame  the  passions  and 
lessen  the  will  power,  and  individuals  who  have  no  intention  of  indulg- 
ing  in   sexual  intercourse  after  a  debauch  will  find  that  they  have 
exposed  themselves  to  at  least  the  possibility  of  infection. 

5.  Prophylaxis. — Prophylaxis  may  be  considered  under  two  head- 
ings: (a)  general,  (b)  personal. 

(a)  General. — Brothels  and   saloons  should  be  cleared  out  from 
the  vicinage  of  training  stations  and  camps.     Prostitution  should  be 
made  difficult.     Diseased  women  should  be  quarantined  and  treated 
until  they  are  no  longer  capable  of  transmitting  their  infections.     This 
method  has  proved  satisfactory  in  Italy  where  dispensaries  for  the 
examination  and  treatment  of  infected  individuals  have  been  provided. 
Venereal  diseases  should  be  notifiable  just  as  other  infectious  diseases. 

(b)  Personal. — Disciplinary  action  should  be  taken  against  officers 
and  men  who  develop  venereal  diseases  if  after  exposure  they  have  not 
availed  themselves  of  personal  prophylaxis. 

Medical  officers  and  divisional  officers  while  discouraging  prosti- 
tution should  inform  the  men  under  them  that  personal  prophylactic 
measures  must  be  taken  immediately  upon  return  to  the  ship  after 
sexual  intercourse.  This  information  should  be  thoroughly  dissemi- 
nated throughout  the  ship  and  the  venereal  prophylaxis  room  should 
be  open  at  the  hours  during  which  liberty  parties  are  returning. 

A  hospital  corps  man,  carefully  trained  in  the  method  of  prophy- 
lactic treatment,  should  be  in  attendance.  The  medical  officer  should 
not  be  present  as  his  presence  is  apt  to  deter  individuals  from  coming. 
The  hospital  corps  man  should  keep  a  careful  record  showing  the  name 


INFECTIOUS   DISEASES  383 


and  rate  of  the  person  treated  and  hour  and  date  of  all  treatments 
given.  This  record  will  be  of  value  for  reference  when  cases  of  venereal 
disease  report  at  the  sick  bay  for  treatment.  If  the  record  shows  that 
the  individual  has  contracted  venereal  disease  after  having  taken 
prophylactic  treatment,  he  should  not  be  made  the  subject  of  disci- 
plinary action.  If  the  record  shows  that  he  has  not  availed  himself  of 
the  preventive  measures  provided  he  should  be  reported  for  punishment. 

The  prophylactic  treatment  consists  in  thoroughly  scrubbing  the 
parts  with  soap  and  water  and  after  urination  injecting  into  the  urethra 
a  c  per  cent,  protargol  or  10  per  cent,  argyrol  solution.  The  injection 
should  be  made  only  into  the  anterior  urethra,  being  prevented  from 
go  ng  backward  by  pressure  with  the  finger  upon  the  canal.  This 
injection  should  be  repeated  three  times,  each  injection  being  allowed 
to  flow  out,  the  final  one  being  held  for  a  period  of  five  minutes. 

After  the  injection  the  organ  should  be  anointed  with  33  per  cent, 
calomel  ointment  in  lanolin.  This  should  be  thoroughly  rubbed  in, 
especial  attention  being  paid  to  the  region  of  the  frenum.  The 
ointment  should  not  be  washed  off. 

While  perhaps  falling  short  of  the  extravagant  claims  of  enthusiasts, 
cart-fully  carried  out  personal  prophylaxis  undoubtedly  reduces  the 
incidence  of  venereal  diseases  by  its  antiseptic  effect  and  by  its  educa- 
tional results. 

Medical  Director  C.  E.  Riggs,  U.  S.  N.,  reported  the  following 
results  from  3556  prophylactic  treatments  at  the  Naval  Training 
Station,  Norfolk,  Va.: 

Administered  within  Venereal  disease  developed 

First  hour 674  o 

Second  hour 657  4 

Third  hour 298  2 

Fourth  hour 223  i 

h  hour 156  3 

Sixth  hour 285  4 

Seventh  hour 247  5 

Eighth  hour.  .         .  .  359  16 

Ninth  hour.          .  .  272  9 

Tenth  hour 190  10 

Eleventh  hour  or  over 195  13 

Total         3,556  67 


384  NAVAL  HYGIENE 

These  figures  emphasize  the  necessity  for  immediate  prophylactic 
treatment  after  exposure. 

The  percentage  of  men  who  developed  the  disease  despite  prophy- 
lactic treatment  taken  within  three  hours  after  exposure  was  0.37 
while  the  percentage  among  those  who  allowed  nine  hours  to  expire 
before  prophylactic  treatment  was  5.97. 

The  distribution  of  prophylactic  remedies  to  men  as  they  go  on 
liberty  has  not  met  with  general  approval,  because; 

(a)  It  suggests  sexual  congress  to  them; 

(b)  It  probably  causes  more  exposures; 

(c)  Too  frequently  men  who  indulge  in  illicit  sexual  intercourse 
are  too  drunk  to  apply  the  prophylactic  properly. 

DIPHTHERIA 

Diphtheria  is  an  acute  communicable  disease  due  to  Bacillus  diph- 
theria, and  characterized  by  the  formation  of  a  membrane  at  the  site 
of  infection,  great  prostration,  and  albuminuria. 

In  training  stations  and  aboard  ship  it  appears  from  time  to  time 
in  epidemic  form,  spreading  slowly  except  in  milk-borne  epidemics 
when  the  outbreak  affects  many  persons  simultaneously.  Low  tem- 
perature retards  dessication  and  prolongs  the  life  of  Bacillus  diph- 
theria. Coughs  tend  to  spray  droplets  of  infected  saliva. 

Bacteriology. — The  specific  cause  of  diphtheria  is  a  Gram  positive, 
non-motile  bacillus,  often  clubbed  in  shape,  and  showing  striking 
parallelism  in  microscope  preparations  made  from  an  eighteen-hour 
culture  on  blood  serum.  The  bacillus  forms  no  spores  and  stains 
readily  by  usual  methods. 

Tendency  to  bi-polar  staining  is  shown  with  all  stains  but  is  best 
shown  by  the  Ponder  method. 

In  suspected  cases  a  diagnosis  may  be  made  from  a  throat  smear 
in  about  25  per  cent,  of  the  cases  of  diphtheria  fifteen  or  eighteen  hours 
before  the  culture  can  be  pronounced  positive.  Valuable  time  thus  is 
gained.  This  procedure  should  not  be  neglected. 

Gram  positive  bacilli  are  found  in  the  mouth.  These  usually 
are  large  harmless  saprophytes.  The  finding  of  a  small  Gram-positive 
bacillus  in  a  throat  smear  from  a  suspicious  case  warrants  immediate 
isolation.  Bacillus  diphtheria  is  easily  killed  and  does  not  readily 
withstand  heat  or  drying.  It  is  killed  in  ten  minutes  at  temperature 
122°  to  i36°F. 


INFECTIOUS    DISEASES  385 


Period  of  Incubation. — The  period  of  incubation  is  from  two  to 
seven  days. 

Mode  of  Transmission : 

r.  By  contact  with  a  person  infected  with  diphtheria; 

2.  By  droplet  infection; 

.5.  By  articles  soiled  with  diphtheritic  membrane; 

4.  By  pet  animals; 
By  milk; 

On  board  ship  where  conditions  of  temperature  and  humidity 
favor  survival  of  the  organism  it  is  highly  probable  that  the  dish 
clot  is,  which  are  none  too  frequently  boiled,  are  an  important  factor 
in  disseminating  the  disease  from  one  piece  of  infected  mess  gear  to 
another. 

Handling  an  Outbreak. —When  a  case  of  diphtheria  develops  on 
board  ship  the  individual  should  be  given  antitoxin  and  isolated  at 
once.  All  contacts  should  be  isolated  if  practicable.  Usually  this 
cannot  be  done.  There  is  a  point  at  which  theory  and  practice  must 
agree  upon  a  rational  modus  vivcndi. 

If  a  diphtheria  case  should  develop  in  room  1152  of  a  big  hotel, 
the  infected  individual  would  be  moved  out  and  the  room  disinfected. 
Quarantine  of  the  hotel  would  not  be  considered.  Aboard  ship  similar 
line  of  action  should  be  followed.  Visiting  parties  to  and  from  the 
ship  should  be  discouraged  but  the  normal  activities  of  the  ship  should 
not  be  disturbed. 

The  mess  gear  should  be  thoroughly  boiled  and  the  drinking 
terminals  at  the  scuttle-butt  should  be  flamed  at  least  once  daily  with  a 
gasolene  torch.  Cuspidors  all  over  the  ship  shoulol  be  boiled. 

Divisional  officers  should  be  instructed  to  direct  any  man  feeling 
sick,  especially  if  the  throat  is  sore,  to  report  for  examination  at  once. 

If  other  cases  develop  the  ship  should  be  placed  in  close  quarantine, 
and  when  practicable  should  proceed  to  the  nearest  port  where  facilities 
will  be  available: 

(a)  For  transfer  of  sick  to  hospital; 

(b)  For  obtaining  antitoxin  to  meet  needs; 

(c)  For  complete  disinfection; 

I    >r  opportunity  to  send  the  crew  into  camp  or  barracks  ashore. 

The  throats  of  all  hands  should  be  inspected  daily  and  all  should  be 

given  an  antiseptic  gargle.     This  should  occur  at  an  hour  when  a 

minimum  of  interference  with  ship's  activities  will  result.     The  best 


NAVAL  HYGIENE 


time  is  just  before  the  noon  meal  because  (a)  the  throats  are  apt  to  be 
free  of  food  particles  and  (£)  the  daylight  is  bright. 


FIG.  131. — Marines  in  life-preservers  in  the  war  zone.  They  are  filing  past  the 
point  where  their  mess-gear  is  immersed  in  boiling  water  immediately  before  receiv- 
ing their  rations. 

The  examination  should  be  made  on  deck  if  weather  permits.  The 
medical  officer  should  select  a  place  on  deck  where  there  is  room  lor  his 


INFECTIOUS   DISEASES  387 


rk  and  should  take  his  stand  with  his  face  toward  or  away  from  the 
direct  rays  of  the  sun,  depending  upon  whether  he  desires  to  use  a  head 
mirror  or  direct  illumination.  He  should  stand  upon  a  box  of  conven- 
ient height  to  enable  him  to  look  down  into  the  throats  and  also  to 
render  him  sufficiently  conspicuous. 

On  his  extreme  right  should  be  stationed  a  chief  pharmacist's 
mate  to  check  off  the  members  of  the  crew  from  a  list  of  billet  numbers 
to  be  supplied  from  the  executive  office. 


132. —  Medical  officers  inspecting  the  throats  of  members  of  the  crew  of  a 
battleship  during  an  outbreak  of  diphtheria. 

On  his  immediate  right  should  stand  a  hospital  corps  man  whose 
duty  it  is  to  supply  the  examiner  with  wooden  tongue  depressors  and 
to  instruct  those  being  examined  to  open  the  mouth  and  say  "ah." 

On  the  immediate  left  should  be  placed  a  galvanized  iron  bucket 
to  receive  the  wooden  tongue  depressors  after  their  use.  This  bucket 
should  be  elevated  to  the  level  of  the  examiner's  waist.  If  the  examiner 
is  on  deck  the  saliva-soiled  tongue  depressor  may  be  carried  by  the  wind 
arid  may  fall  to  the  deck  instead  of  into  the  bucket.  A  hospital  corps 


388  NAVAL  HYGIENE 

man  with  pencil  and  paper  should  stand  here  ready  to  take  the  name  of 
any  man  whose  throat  requires  further  examination.  To  the  left  of 
the  bucket  should  be  placed  a  mess  table  behind  which  several  hospital 
corps  men  can  stand  and  fill  paper  cups  with  the  antiseptic  gargle.  To 
the  left  of  the  mess  table  should  be  two  immersion  tubs  (from  a  handling 
room)  into  which  the  gargle  may  be  spat  after  gargling.  Ten  men 
easily  may  stand  around  each  tub  to  gargle. 

Finally,  a  large  receptacle  should  be  placed  to  the  left  of  the  immer- 
sion tubs  to  receive  the  discarded  paper  cups  of  the  men  who  have  just 
gargled.  The  divisions  should  fall  in  by  billet  numbers.  These  are 
much  more  quickly  checked  off  than  names.  The  division  marching 
single  file  should  approach  and  pass  by  the  examining  party,  the  follow- 
ing being  done : 

The  individual  is  checked  by  billet  number  and  examined  by  the 
medical  officer.  A  chalk  mark  on  the  deck  will  aid  the  man  in  taking 
his  stand  in  the  desired  position  as  he  approaches  the  examiner.  Re- 
moval of  the  cap  renders  the  neck  more  supple  as  the  man  will  not 
stiffen  his  neck  to  avoid  losing  his  cap. 

If  the  throat  appears  normal  the  man  passes  to  the  table,  gets  his 
gargle,  uses  it,  spits  it  into  the  immersion  tank,  throws  the  paper  cup 
into  the  receptacle,  and  goes  his  way. 

If  a  throat  appears  sore,  or  tonsillar  crypts  have  an  exudate,  the  man 
is  told  to  fall  out  and  report  at  the  sick  bay  for  further  examination. 

Cooperation  between  the  administrative  authorities  and  the 
medical  officer  will  enable  continuous  examination  by  the  latter, 
yet  the  interference  with  ship's  work  will  be  slight. 

Unless  a  careful  checking  system  is  adopted  the  most  dangerous 
man  may  be  overlooked.  Feeling  sick,  he  may  crawl  away  and  secrete 
himself,  thus  missing  examination  and  remaining  an  undetected  menace 
to  others.  About  1000  or  more  sanitary  paper  cups  and  as  many 
tongue  depressors  are  needed  for  each  examination.  These  daily 
examinations  must  be  continued  until  the  expiration  of  the  period  of 
incubation  after  the  last  case  has  developed;  consequently,  the  medical 
officer  of  a  battleship  should  have  no  hesitancy  in  making  requisition  for 
what  may  seem  a  very  large  supply  of  culture  media,  tongue  depressors, 
sanitary  paper  cups,  disinfectants,  and  materials  for  preparing  gargles. 
When  it  is  possible  to  isolate  contacts  the  Schick  test  should  be  applied 
and  an  immunizing  dose  of  antitoxin,  or  of  the  toxin-antitoxin  mixture 
should  be  administered  to  all  who  give  a  positive  Schick  reaction. 


INFECTIOUS   DISEASES  389 

The  results  obtained  from  use  of  the  toxin-antitoxin  mixture  are 
said  to  produce  an  enduring  immunity.  Park  and  Zingher  using  i  c.c. 
loxin-antitoxin  mixture  at  intervals  of  one  week  for  three  weeks 
produced  an  immunity  which  continued  for  a  year  and  a  half,  i.e., 
so  long  as  the  cases  were  under  observation.  They  consider  it  advis- 
able to  start  immunization  after  the  first  year  of  life.  The  immuni- 
sation acquired  by  this  method  is  produced  slowly;  consequently,  may 
not  be  depended  upon  in  the  presence  of  diphtheria  outbreak.  The 
administration  of  antitoxin  to  diphtheria  contacts  in  the  Navy  is 
regarded  as  undesirable  except  perhaps  in  cases  of  nurses  or  attendants 
who  #ive  positive  Schick  reaction.  The  immunity  acquired  as  result 
of  administration  of  antitoxin  lasts  only  about  three  weeks  and  sen- 
sitizes the  body  against  the  horse  serum  which  would  have  to  be  given 
in  massive  dose  should  the  individual  thus  immunized  develop  diph- 
theria. As  result  of  this  sensitization  dangerous  anaphylactic  reaction 
may  develop  when  the  large  therapeutic  dose  is  necessary.  Those 
suffering  with  diphtheria  should  not  be  permitted  to  go  out  of  quarantine 
until  three  successive  cultures  taken  at  least  twenty-four  hours  apart 
have  shown  that  their  throats  and  noses  are  free  of  diphtheria  bacilli. 

Kven  after  this  precaution,  an  occasional  instance  is  seen  in  which 
diphtheria  is  conveyed  by  one  who  has  been  pronounced  free  from  the 
disease  after  the  employment  of  the  usual  laboratory  safeguards. 

An  instance  illustrating  this  possibility  occurred  recently  in  which 
;.n  individual  showing  a  positive  culture  for  diphtheria  was  trans- 
ferred to  an  isolation  hospital. 

He  was  isolated  on  the  i;th  of  October  and  came  out  of  quarantine 
on  the  3oth  of  October,  after  six  successive  negative  cultures  had  been 
taken.  After  the  period  of  incubation  following  his  return  a  case  of 
diphtheria  developed,  and  this  was  followed  by  six  other  cases,  all  from 
the  same  squad  room. 

The  laboratory  -howcd  that  the  original  case  was  a  carrier  of  virulent 
diphtheria  bacilli. 

Taking  the  Culture. — A  culture  should  be  taken  in  all  cases  where 
there  i-  an  exudate  on  the  tonsils  or  mucous  membrane  of  the  throat. 

Observance  of  this  rule  will  save  trouble  in  the  end.     Diphtheria 

will  be  ret  <>mii/cd  before  there  has  Urn  opportunity  for  the  wide  spread 

of   the   infection.      A   culture   should    be   taken    before    the   patient  has 

;in   antiseptic   i^irtfle.      I'nless  cultures  are   taken   also  from   the 

nose  the  work  is  but  half  done. 


39°  NAVAL   HYGIENE 

In  smearing  the  swab  over  the  surface  of  the  blood-serum  tube, 
care  should  be  taken  not  to  exert  pressure  sufficient  to  break  the 
surface  of  the  medium.  When  blood  serum  is  not  available,  a  medium 
made  of  mixed  yolk  and  white  of  egg  will  serve. 

Good  results  have  been  obtained  by  using  the  surface  of  a  hard- 
boiled  egg,  after  cutting  with  a  sterile  knife  and  incubating. 

Carriers. — It  has  been  estimated  that  2  per  cent,  of  individuals 
harbor  the  diphtheria  bacillus.  In  times  of  epidemic  the  percentage 
may  be  increased  to  30  or  40  per  cent.  These  healthy  carriers  are  a 
potent  factor  in  the  spread  of  the  disease,  in  that  they  present  no  clinical 
symptoms,  consequently  they  are  not  recognized  as  disease  carriers, 
except  perhaps  by  accident. 

Occasionally  the  bacillus  persists  for  long  periods  of  time  in  the 
throats  and  noses  of  those  who  have  suffered  from  the  disease. 

Unless  the  throat  is  clear  at  the  end  of  four  weeks,  virulence  tests 
should  be  made,  and  if  the  organisms  are  found  to  be  non-virulent  the 
individual  should  be  permitted  to  resume  his  normal  activities. 

Milk. — Milk  may  become  infected  with  the  diphtheria  bacillus, 
and  be  a  grave  menace  to  those  using  it. 

An  outbreak  resulting  from  infected  milk  is  fulminant  in  character, 
a  number  of  cases  appearing  at  the  same  time.  Pasteurization  of 
milk  will  exclude  this  article  of  food  as  a  diphtheria  carrier. 

The  writer  has  been  impressed  with  the  concurrence  of  diphtheria 
and  Vincent's  angina  in  outbreaks  of  the  former  disease.  In  an 
outbreak  of  diphtheria  on  the  U.  S.  S.  North  Dakota  several  cases 
of  Vincent's  angina  were  discovered,  all  of  which  were  negative  for  the 
diphtheria  bacillus. 

WHOOPING  COUGH 

Whooping  cough  is  seen  occasionally  in  the  naval  service  and  is 
mentioned  because  of  the  large  number  of  young  men  in  the  service. 
While  it  is  a  disease  of  youth  I  have  seen  a  man  sixty -six  years  old  in  an 
attack. 

The  specific  cause  is  the  Bacillus  pertussis  or  the  Bordet-Gengou 
bacillus. 

Mode  of  transmission  is  through  articles  soiled  by  the  sputum  of 
those  sick  with  the  disease  or  by  droplet  infection. 

Incubation. — The  period  of  incubation  is  from  two  to  fourteen 
days. 


INFECTIOUS    DISEASES  39 1 

Immunity. — One  attack  confers  lasting  immunity.  Hess  claims 
success  in  using  vaccines  of  B.  pertussis  as  a  prophylactic. 

Prophylaxis. — Patients  should  be  isolated  until  two  weeks  after 
development  of  the  whoop.  Contact  should  be  avoided.  Disinfection 
similar  to  that  for  other  sputum-borne  disease  should  be  practised. 
\\Tooping  cough  is  a  dangerous  disease  because  of  the  too  common 
bronchitis  which  complicates  it. 

GERMAN  MEASLES 

German  measles  is  very  common  among  the  recruits  at  training 
stations,  and  aboard  ship.  It  spreads  rapidly,  and  but  for  its  usual 
mildness  would  be  a  grave  problem. 

The  causative  organism  of  German  measles  is  unknown. 

Mode  of  Transmission. — It  is  generally  assumed  to  be  transmitted 
by  contact  (droplet  method)  or  by  articles  soiled  by  the  sputum  of  those 
sick  of  the  disease. 

Incubation. — The  period  of  incubation  is  about  ten  days. 

Immunity. — One  attack  confers  a  lasting  immunity. 

Prophylaxis. — Avoid  contact  with  the  disease.  Isolate  patient 
for  eight  days  after  the  onset  of  the  disease,  or  longer  if  catarrhal 
symptoms  persist.  Disinfection  as  for  sputum-borne  disease  should  be 
practised. 

The  disease  is  mild,  but  grave  broncho-pneumonia  may  complicate 
it. 

(    I  R  KBRO-SPINAL    FEVER 

Cerebro-spinal  fever  is  an  acute,  infectious  disease  caused  by  Diplo- 
coccus  intracellularis  mcnin^itidis  ( Weichselbaum) . 

Prevalence. — Cerebro-spinal  fever  is  a  disease  associated  with  over- 
ling. Rosenau  refers  to  it  as  "a  disease  of  infants  and  soldiers." 
It  i-  prevalent  in  this  country  and  in  Europe  and  appears  from  time  to 
time  in  localized  outbreaks  in  various  armies  of  the  world,  as  well  as 
among  naval  forces.  In  our  Navy  from  1906  to  1916  the  morbidity 
rate  of  cerebro-spinal  fever  has  tluctuated  from  0.64  per  1000  in  1907 
to  0.028  per  1000  in  1916.  This  variation  appears  to  be  dependent 
upon  the  movement  of  the  disease  among  tin-  civilian  population  from 
win -in  the  recruits  are  drawn  rather  than  any  conditions  peculiar  to  the 
naval  service.  Recruits  coming  from  foci  of  infection  introduce  the 


3Q2  NAVAL   HYGIENE 

disease  into  the  ship  or  training  station  to  which  they  are  first  sent, 
and  there  the  essential  conditions  of  the  naval  service  favor  spread  of 
the  infection.  There  was  a  marked  increase  in  the  incidence  of  cere- 
bro-spinal  fever  following  the  sudden  expansion  of  the  Navy  after  the 
declaration  of  war  against  Germany.  The  rapid  enlistment  caused 
overcrowding  at  the  training  stations  and  recruits  were  sent  directly 
to  ships  without  undergoing  the  usual  period  of  detention  and  obser- 
vation required  in  peace  times. 

Bacteriology . — The  specific  cause  of  cerebro-spinal  fever  is  a  Gram- 
negative  diplococcus  resembling  morphologically  the  gonococcus.  It  is 
often  referred  to  as  the  "meningococcus."  The  organism  is  found  in 
the  nasal  secretions  of  patients  and  of  healthy  carriers.  It  is  believed 
to  invade  the  system  through  the  nose,  and  the  roof  of  the  nasal  pharynx 
is  the  common  site  from  which  it  may  be  isolated.  The  organism  is 
found  in  the  pus  cells  from  the  cerebro-spinal  fluid  of  patients.  The 
meningococcus  has  low  resistance  and  soon  is  destroyed  by  sunlight 
and  dessication.  It  dies  easily  even  under  laboratory  conditions. 

Period  of  Incubation. — At  a  training  camp  cerebro-spinal  fever  was 
introduced  by  drafts  from  a  training  station.  A  man  ill  with  the 
disease  was  taken  from  the  train  upon  arrival  on  December  29. 

Only  one  case  developed  among  the  men  who  were  at  the  camp  before 
the  arrival  of  the  draft.  This  case  was  the  man  who  took  the  names 
of  the  members  of  the  draft  which  arrived,  i.e.,  was  in  close  contact 
with  the  sick  man  who  arrived  on  the  train  December  29.  He  devel- 
oped the  disease  January  7. 

In  the  above-mentioned  case  a  period  of  incubation  between  expo- 
sure of  a  man  from  an  uninfected  camp  to  a  known  case  of  cerebro- 
spinal  fever  appears  to  have  been  nine  days. 

Ten  cases  occurred  among  men  from  this  training  station. 

Healthy  Carriers. — Elser  and  Huntoon  have  pointed  out  the  role 
of  healthy  carriers  in  spreading  cerebro-spinal  fever.  From  40  to  70 
per  cent,  of  healthy  persons  exposed  to  the  disease  become  carriers  and 
are  capable  of  transmitting  it  for  a  period  of  at  least  thirty  days.  It  is 
estimated  that  there  are  ten  carriers  for  every  case. 

On  board  a  ship  7.24  per  cent,  of  carriers  were  found  among  a  crew 
of  649.  In  a  training  camp  6.45  per  cent,  were  found  among  527 
persons  cultured. 

Immunity/ — One  attack  does  not  confer  lasting  immunity.  The 
death  rate  in  untreated  cases  is  70  per  cent.  There  appears  little  hope 


INFECTIOUS    DISEASES 


393 


for  widespread  immunity  similar  to  that  which  has  resulted  from  mea- 
sles. Killed  cultures  of  the  meningococcus  have  been  employed  in  an 
effort  to  produce  immunity.  Favorable  results  have  been  reported. 
Immunity  is  said  to  be  produced  one  year  after  the  injections;  conse- 
quently, the  method  cannot  be  used  for  the  protection  of  contacts 
during  an  acute  outbreak. 

Prophylaxis. — In  the  naval  service  cultures  should  be  taken  of  all 
recruits  immediately  upon  their  arrival  at  training  stations  or  barracks. 
Recruits  should  be  placed  in  a  detention 
barracks  or  camp  for  a  period  of  three 
weeks  for  the  dual  purpose  of  obtaining 
results  from  cultures  of  the  throat  and 
nasal  mucosa  and  to  give  abundant  time 
for  the  development  of  any  infectious 
disease  to  which  the  recruit  may  have 
been  exposed.  If  healthy  carriers  are 
found,  they  should  not  be  permitted  to 
join  the  men  in  the  barracks  or  to  go 
on  board  ship  until  they  are  no  longer 
carriers.  Healthy  carriers  should  receive 
treatment  for  the  nose  and  throat  with  a 
view  to  kill  the  infection.  Chloramin 
solution  0.5  to  i  per  cent,  in  strength  is 
the  best  agent  for  this  purpose.  Other  FlG.  I33.— Taking  a  culture 

antiseptic   gargles   and   sprays  are  Useful,    from  the  naso-pharynx.     A   bent 

.     ,.    .  .     glass  tube  carries  the  swab  which 

Despite  active  treatment,  some  mdivid-  is  thrust  out  after  the  glass  tube 
uals  remain  carriers  for  indefinite  periods  is  in  position.  This  avoids  infec- 

,.     .  tion  with  organisms  in  the  saliva. 

ol  time. 

In  the  presence  of  an  outbreak  of  the  disease,  patients  should  be 
isolated  immediately;  all  contacts  should  be  placed  under  observation 
and  should  be  cultured  to  detect  the  carriers.  Those  attending  the 
patient  should  be  especially  careful  to  avoid  proximity  to  patient 
during  his  snee/ing  or  roughing.  Respirators  should  be  worn.  Dis- 
charges from  the  nose  and  throat  and  all  articles  soiled  by  them  should 
be  thoroughly  disinfected.  The  throats  and  noses  of  patients  should 
be  treated  with  antiseptic  solutions  as  gargles  or  sprays. 

Both  concurrent  and  terminal  disinfection  should  he  practised. 
Convalescent  should  he-  isolated  until  four  successive  cultures  taken  live 
days  apart  show  the  naso-pharynx  to  be  free  from  the  meningococci. 


394  NAVAL   HYGIENE 

MEASLES 

Measles  is  an  acute,  dangerous,  communicable'  disease,  due  to  a 
filterable  virus,  which  was  discovered  by  Goldberger  and  Anderson. 
Several  observers  have  reported  organisms  believed  to  play  a  causative 
role  in  the  production  of  measles,  but  the  specific  organism  has  not 
been  discovered. 

The  period  of  incubation  is  fourteen  days,  rarely  eighteen. 

Mode  of  Transmission. — Measles  is  spread  through  the  secretions 
from  the  mouth  and  nose  of  infected  individuals  or  by  immediate  con- 
tact with  the  person  suffering  from  the  disease.  It  is  communicable 
during  the  period  of  catarrhal  symptoms  and  possibly  for  a  brief  period 
after  their  disappearance. 

Cases  should  be  regarded  as  capable  of  transmitting  the  disease  for 
a  period  beginning  five  days  before  the  eruption  and  extending  to  one 
week  after  the  eruption.  The  height  of  infectivity  is  reached  at  the 
beginning  of  the  eruption. 

Measles  is  the  most  readily  communicable  of  all  infectious  diseases. 
One  observer  found  that  only  14  per  cent,  of  susceptible  children  escaped. 
Its  ravages  among  a  people  who  have  not  acquired  immunity  through 
generations  of  infection  are  extremely  appalling. 

During  the  measles  epidemic  in  Fiji  in  1875  more  than  40,000 
out  of  1 50,000  persons  are  said  to  have  died  because  this  isolated  people 
had  no  immunity,  the  disease  having  been  unknown  in  Fiji  up  to 
the  time  of  the  outbreak. 

Aside  from  the  immediate  danger  caused  by  measles  the  dangerous 
complications  which  often  attend  it  should  cause  it  to  be  regarded  as 
a  highly  fatal  disease.  The  fever  with  its  effect  upon  the  myocardium, 
the  bronchitis,  pneumonia,  and  eye  and  ear  complications,  are  among 
its  immediate  and  dangerous  by-effects.  The  lowering  of  resistance 
and  vitality  consequent  upon  an  attack  of  measles  often  results  in 
lighting  up  a  latent  tuberculous  infection. 

Prophylaxis. — Among  troops  and  on  board  ship  the  appearance  of 
measles  should  be  regarded  with  much  concern.  The  concentration 
of  men  within  small  space  renders  inevitable  the  exposure  of  many 
individuals  during  the  period  of  incubation,  and  if  these  "contacts" 
are  non-immune,  the  appearance  of  the  disease  in  epidemic  form  is 
to  be  expected. 

When   measles   appears   it   should   be   isolated   immediately,  and 


INFECTIOUS   DISEASES  395 

all  known  contacts  should  be  isolated  also  until  the  expiration  of  the 
period  of  incubation,  namely  fourteen  days.  The  effects  of  the  sick 
man  should  be  disinfected  at  once;  this  includes  clothing,  bedding, 
mess  gear,  and  especially  handkerchiefs. 

In  1901-1902,  Medical  Director  H.  G.  Beyer,  U.  S.  Navy,  demon- 
strated that  measles  can  be  controlled  by  rigorous  quarantine  and  anti- 
septic precautions  when  he  had  an  outbreak  of  measles  on  a  training 
ship  and  the  complement  consisted  mainly  of  young  and  susceptible 
adults. 

Recently  Colonel  E.  L.  Munson  of  the  U.  S.  Army  Medical  Corps 
has  confirmed  Beyer's  observations  by  demonstrating  the  absolute 
conl  rol  of  a  measles  epidemic  when  rigorous  measures  are  applied  along 
rational  lines. 

This  demonstration  occurred  among  the  troops  on  the  Mexican 
border,  and  while  the  disease  was  stamped  out  of  the  military  organi- 
zations in  which  it  appeared,  it  persisted  among  the  civilian  population 
in  the  vicinage  of  the  camps. 

Upon  the  appearance  of  the  disease  and  isolation  of  the  patient 
and  of  the  contacts,  all  members  of  the  command  should  be  kept  under 
close  observation.  They  should  be  inspected  by  the  medical  officer 
daily,  preferably  morning  and  evening.  Those  having  fever  should 
be  isolated  at  once,  and  the  buccal  mucosa  should  be  carefully  examined 
for  the  appearance  of  Koplik  spots.  Coryza,  conjunctivitis,  skin 
eruption  or  bronchitis  should  be  sufficient  to  place  an  individual  in 
isolation  for  observation,  as  these  catarrhal  symptoms  probably  are 
prodromal. 

Nurses  and  hospital  corps  men  attendant  upon  measles  should 
be  selected  from  those  who  give  a  history  of  the  disease  themselves, 
and  who  reasonably  may  be  supposed  to  possess  an  acquired  immunity. 
Everything  which  comes  in  contact  with  the  patient  should  be  care- 
fully disinfected.  This  applies  especially  to  mess  gear,  handkerchiefs, 
and  discharges  from  the  mouth  and  nose. 

The  room  should  be  kept  dark  to  prevent  the  patient  from  undue 
eye  strain  during  the  period  of  conjunctival  irritation.  The  nasal- 
pharynx  should  be  treated  with  some  antiseptic  solution  with  a  view 
to  prevent  extension  of  infectious  secretions  to  the  eustachian  tube  and 
consequent  suppurativc  disease  of  the  middle  ear.  Chilling  should 
be  avoided  in  order  to  prevent  a  further  predisposition  to  pulmonary 


396  NAVAL   HYGIENE 

infections.     Upon  recovery  individuals  should  take  an  antiseptic  bath 
— bichloride  of  mercury  i  to  1000  or  carbolic  acid  i  per  cent. 

Hair,  finger  nails,  and  toe  nails  should  be  carefully  disinfected. 
Nose  and  mouth  should  be  treated  with  an  antiseptic  solution  and  the 
external  auditory  canal  should  be  washed  out  with  70  per  cent,  alcohol. 
The  individual  should  then  be  dressed  in  freshly  disinfected  clothing 
before  being  permitted  to  mingle  with  other  members  of  the  command. 

SCARLET  FEVER 

Scarlet  fever  is  an  acute  communicable  disease  characterized  by  high 
fever,  angina,  an  exanthem,  and  frequently  by  serious  complications. 
The  period  of  incubation  is  "from  one  to  seven  days,  oftenest  from  two 
to  four"  (Osier).  McCollam  states  that  the  average  period  is  ten  to 
fourteen  days.  The  latter  figures  are  regarded  as  extreme,  those  quoted 
by  Osier  being  more  nearly  in  accordance  with  the  writer's  experience. 
Scarlet  fever  is  rare  in  tropical  countries. 

Bacteriology. — The  specific  cause  of  scarlet  fever  is  not  known. 
Several  organisms  have  been  described,  yet  none  has  received  sufficient 
confirmation  of  its  specificity  to  be  accepted  as  the  cause. 

A  Gram-positive  "  Bacillus  scarlatinae"  has  been  described  by 
Mallory  and  Medlar,  who  regard  it  as  the  cause  of  scarlet  fever.  This 
organism  is  said  to  be  found  in  the  tonsils  or  about  them.  A  protozoon 
found  in  blisters  on  the  skin  of  scarlet-fever  patients  has  been  regarded 
as  cause.  Other  workers  describe  a  "Diplococcus  scarlatinae"  which 
they  claim  to  have  found  in  the  urine,  blood,  desquamated  epithelium, 
and  throat. 

Regardless  of  the  claims  made  for  the  several,  organisms  abova 
mentioned  there  is  general  agreement  that  Streptococcus  pyo genes 
is  commonly  found  in  joint  complications  and  throat,  some  pathologists  j 
believing  it  to  be  the  specific  cause  of  scarlet  fever. 

Immunity. — One  attack  usually  confers  lasting  immunity,  although 
individuals  are  seen  who  have  experienced  two  or  more  attacks.  Since; 
the  specific  cause  is  not  known  methods  of  producing  artificial  immunity  i 
have  been  unsuccessful. 

Although  scarlet  fever  is  regarded  as  a  disease  of  children,  adults 
often  are  attacked.  Out  of  166,000  cases,  n  per  cent,  were  past  the! 
age  of  sixty  years. 

Scarlet  fever  is  a  highly  fatal  disease  in  children  under  ten  years  of 
age,  92  per  cent,  of  the  deaths  from  the  disease  being  in  this  age  group.  < 


IMKCTIOUS   DISEASES 


397 


Mode  of  Infection. — i.  Contact.  —Scarlet  fever  is  spread  by  contact 
wit!  persons  having  the  disease.  It  is  not  so  contagious  as  measles. 
Ofu  n  onl\  one  or  two  cases  will  appear  among  a  ship's  company. 

2.  Milk. — Numerous  instances  are  on  record  to  show  the  trans- 
mis- ion  of  scarlet  fever  by  milk.     It  is  said  that  cows  may  transmit 
the  disease.     Kober  has  studied  ninety-nine  milk-borne  outbreaks  of 
scarlet  fever,  and  in  sixty-eight  of  the  number  he  found  that  scarlet 
fever  was  prevalent  either  at  the  dairy  or  farm  from  which  milk  was 
being  supplied. 

3.  Fomitcs. — Clothing  or  articles  such  as  books,  toys,  etc.,  soiled 
by  the  discharges  from  nose  or  throat  of  scarlet-fever  patients  may  be 
infectious.     In  this  connection  transmission  of  the  disease  by  a  third 
person   should   be   remembered. 

!er  mentions  a  case  in  which  no  other  mode  of  infection  was 
probable,  and  considered  himself  as  the  carrier  in  that  instance.  When 
the  r-peciric  cause  is  known  healthy  carriers  undoubtedly  will  be  demon- 
strated. The  specific  virus  appears  to  be  inhaled  into  the  throat, 
take-i  with  the  food  (milk),  and  the  disease  appears  transmissible 
through  the  blood,  as  children  are  born  with  scarlet  fever. 

Wounds  appear  to  be  a  predisposing  cause.  The  incidence  of  the 
disease  among  women  after  childbirth  is  more  than  coincidence. 

Scarlet  fever  has  been  communicated  to  monkeys  by  swabbing 
their  throats  with  material  from  the  throats  of  scarlet-fever  patients. 

Quarantine. — Persons  sick  of  scarlet  fever  should  be  isolated  imme- 
diate ly  and  contacts  constantly  watched  for  throat  symptoms,  fever 
or  eruption.  The  quarantine  should  last  for  a  period  of  eight  weeks, 
unites  the  nasal  and  throat  symptoms  have  entirely  disappeared  and 
desquamation  has  ceased. 

Out  of  a  uroup  of  3800  cases  79  had  been  infected  by  persons  returned 
from  hospital  alter  treatment  for  M -arlet  fever.  These  "return  cases" 
indicate  need  for  close  quarantine  and  careful  disinfection  of  persons 
| who  have  had  the  disease. 

Prophylaxis.  Isolate  at  once.  Watch  contacts  carefully.  Their 
[throats  should  be  inspected,  temperature  taken  daily,  and  any  sore 
throat  or  fever  should  receive  prompt  attention.  Non-immunes 
who  are  in  contact  with  scarlet  fever  should  use  an  antiseptic  throat 
le.  All  mess  gear  and  linen  should  be  sterilized.  All  articles 

idled  by  the  patient  should  be  disinfected  a>  should  be  bath  water 
dejecta. 


398  NAVAL   HYGIENE 

During  the  course  of  the  disease  the  patient's  skin  should  be  kept 
anointed  with  vaseline  or  some  bland  ointment  to  prevent  the  blowing 
about  of  scales. 

When  the  patient  is  to  be  taken  out  of  isolation  he  should  be  given 
an  antiseptic  bath  with  a  view  to  disinfect  the  epithelial  structures 
thoroughly.  Finger  and  toe  nails  should  be  cut  and  thoroughly 
cleaned,  the  hair  and  entire  body  should  receive  an  antiseptic  bath; 
special  attention  being  given  to  the  umbilicus.  The  external  auditory 
canal  should  be  disinfected  with  alcohol,  and  the  nose  and  throat 
should  be  thoroughly  cleansed  with  an  antiseptic  gargle. 

SMALLPOX 

Smallpox  is  an  acute,  communicable,  highly  fatal,  and  directly 
preventable  disease. 

Prevalence. — Owing  to  neglect  of  vaccination  in  some  sections  and 
half-hearted  enforcement  of  compulsory  vaccination  in  other  sections, 
smallpox  appears  frequently  in  our  country. 

Although  it  is  regarded  as  a  type  of  the  most  contagious  disease  and 
although  the  naval  forces  of  the  United  States  are  serving  in  every 
quarter  of  the  globe  where  smallpox  is  endemic,  compulsory  vaccination 
upon  enlistment  has  made  smallpox  a  clinical  curiosity  in  the  Navy. 

Period  of  incubation  is  twelve  to  fourteen  days. 

Etiology. — Various  workers  have  attributed  a  causative  role  to 
organisms  both  animal  and  vegetable  discovered  by  them.  The  cause 
remains  unknown. 

Immunity. — One  attack  of  the  disease  confers  lasting  immunity. 
Vaccination  with  cowpox  virus  produces  an  immunity  which  lasts  for 
several  years.  In  the  United  States  Navy  vaccination  is  compulsory 
upon  enlistment  and  each  re-enlistment.  In  the  presence  of  an  epidemic 
of  smallpox  or  in  case  of  contact,  re- vaccination  should  be  practised  re- 
gardless of  dates  of  previous  vaccination. 

Prophylaxis. — Vaccination  prevents  smallpox.  Thoroughly  vac- 
cinated individuals  will  not  contract  the  disease.  Medical  officers 
should  satisfy  themselves  that  all  persons  under  their  charge  are  pro- 
tected by  vaccination.  If  a  case  should  develop  it  should  be  placed 
immediately  in  an  isolation  hospital  or  camp.  Contacts  should  be 
vaccinated  and  isolated  for  observation.  Scrupulously  thorough 
concurrent  and  terminal  disinfection  should  be  practised.  Before  the 


INFECTIOUS   DISEASES  399 

patient  is  permitted  to  return  to  duty  his  entire  body  should  be  entirely 
sliaved ;  eyes,  nose,  and  mouth  treated  thoroughly  with  antiseptic  solu- 
tions, ears  and  umbilicus  should  be  washed  out  with  alcohol,  and  after 
this  the  patient  should  be  given  an  antiseptic  bath,  special  attention 
being  paid  to  the  paring  and  cleansing  of  finger  and  toe  nails.  During 
the  course  of  the  disease  the  place  of  isolation  should  be  thoroughly 
screened  against  insects  and  vermin. 

CHICKEN-POX 

Chicken-pox  is  an  acute  communicable  disease  commonly  con- 
tracted in  childhood,  yet  no  age  is  exempt. 

It  is  usually  regarded  as  a  trivial  affection.  After  the  formation 
of  the  vesicles,  infection  may  occur,  the  complication  giving  a  grave 
aspect  to  a  disease  which  ordinarily  is  mild.  Since  the  course  of  the 
disease  is  mild,  children  should  be  kept  from  school,  but  there  seems 
little  reason  for  isolation  of  contacts.  In  the  military  service  the 
writer  is  of  the  opinion  that  it  is  scarcely  worth  while  to  isolate  cases 
of  chicken-pox. 

The  possibility  of  confusion  of  diagnosis  resulting  in  non-recognition 
of  a  case  of  smallpox,  makes  isolation  seem  worth  while,  not  because 
chicken-pox  is  a  serious  disease,  but  because  smallpox  may  be  mis- 
taken for  it. 

The  Period  of  Incubation. — The  period  of  incubation  of  chicken-pox 
is  fourteen  days.  The  writer  knows  of  no  disease  in  which  the  period 
of  incubation  varies  so  little. 

Bacteriology. — The  specific  organism  causing  chicken-pox  has  not 
been  discovered.  Certain  cell  inclusions  have  been  observed,  and  they 
are  regarded  by  some  as  pathognomonic  of  chicken-pox. 

Immunity. — One  attack  confers  a  lasting  immunity.  The  disease 
is  <>f  such  mild  character  that  artifical  immunization  is  unnecessary. 

Prophylaxis. — The  prevention  of  chicken-pox  lies  in  the  avoidance  of 
contacts.  The  mode  of  transmission  is  unknown  but  it  seems  probable 
that  the  disease  is  communicated  by  droplet  infection.  Susceptible 
persons  should  avoid  contact  with  cases  of  chicken-pox.  The  mess  gear 
and  linen  of  chicken-pox  patient  should  be  disinfected.  The  lesions 
should  not  be  irritated  or  disturbed  as  each  is  a  potential  source  of 
adventitious  infection.  The  height  of  infectivity  is  during  the  eruptive 
stage,  therefore  early  diagnosis  and  isolation  are  desirable  among 


4OO  NAVAL   HYGIENE 

children  if  not  among  adults.  Individuals  should  be  released  from 
isolation  after  the  crusts  have  dropped  off.  It  is  not  known  whether 
chicken-pox  is  transmissible  by  fomites,  nor  is  it  known  whether  healthy 
carriers  spread  the  disease. 

MUMPS 

Mumps  is  an  acute  communicable  disease  the  specific  germ  cause  of 
which  is  unknown.  The  disease  is  believed  to  be  communicated  by 
contact  with  one  suffering  from  mumps  and  with  articles  recently 
soiled  with  oral  or  nasal  secretions  of  the  infected  person.  Experience 
leads  the  writer  to  feel  that  healthy  carriers. of  the  disease  exist,  yet 
this  cannot  be  proved  until  the  specific  germ  is  recognizable. 

Period  of  Incubation.— The  period  of  incubation  is  about  fourteen 
days.  Four  to  twenty-five  days  are  the  extremes.  Mumps  is  said 
to  be  communicable  for  a  period  of  at  least  six  weeks.  It  is  not 
clear  upon  what  this  assumption  is  based.  The  infected  individual 
should  be  regarded  as  capable  of  transmitting  the  disease  during 
the  period  of  swelling  of  the  parotid  and  submaxillary  glands. 

Mumps  is  a  common  disease  among  children  and  often  is  met  in 
epidemic  form  at  training  stations  or  on  board  ship  where  many  sus- 
ceptible young  adults  are  so  closely  crowded  that  contact  with  many 
persons  is  inevitable  during  the  period  of  incubation  of  the  first  case. 

Mumps  usually  is  a  harmless  if  painful  disease,  and  experience 
causes  the  writer  to  feel  that  the  isolation  on  board  ship  and  in  train- 
ing stations  is  barely  if  worth  while.  Every  prophylactic  measure 
is  urged  in  civil  life.  In  military  life  it  seems  desirable  that  this 
uncomfortable  disease  should  be  had  early  in  order  to  acquire  the 
immunity  which  an  attack  confers,  then  the  individual  will  no  longer 
be  susceptible.  The  discomfort  is  no  greater  than  that  produced  by  the 
indispensable  vaccination  against  smallpox.  The  danger  is  nil,  and 
the  individual  will  be  protected  against  possible  incapacity  from  the 
mumps  in  time  of  national  need. 

While  the  U.  S.  Naval  forces  were  occupying  Vera  Cruz,  Mexico,  in  1914,  I 
treated  a  battalion  commander  who  was  ingloriously  driven  from  the  field  of  battle 
by  mumps! 

Early  diagnosis  is  desirable,  especially  if  isolation  and  observation 
of  contacts  are  to  be  practised.  Non-immune  contacts  should  be 
kept  from  public  gatherings  for  at  least  two  weeks  after  exposure. 


INFECTIOUS   DISEASES  401 

There  is  no  iK'iTssity  for  terminal  disinfection  but  scrupulous  c  are 
sh  )uld  be  exerc  i>ed  in  the  execution  of  concurrent  disinfection.  Secre- 
tidiis  from  the  mouth  and  nose,  all  articles  soiled  by  them,  and  espe- 
cially mess  gear,  should  be  carefully  disinfected. 

No  method  of  artificial  immunization  is  known,  but  the  immunity 
conferred  by  an  attack  of  mumps  appears  to  be  permanent. 

PNEUMONIA 

Pneumonia  is  an  acute  infectious  disease  due  to  the  Pneumococcus . 

Bacteriology. — The  Pneumococcus  is  a  Gram-positive,  non-motile, 
non-spore-bearing,  lance-shaped  diplococcus  which  grows  best  on 
blood  serum,  coagulates  litmus  milk,  and  forms  acid  in  inulin  media. 
It  causes  more  than  80  per  cent,  of  the  cases  of  pneumonia  (Stitt) 
wl  ether  it  be  of  the  croupous,  catarrhal  or  septic  type. 

1  our  types  of  the  Pneumococcus  have  been  isolated,  the  types 
'.tig  specifically  with  their  homologous  immune  sera. 

( )f  the  four  types,  type  I  and  type  II  cause  64  per  cent,  of  the  cases 
of  pneumonia.  The  mortality  for  these  groups  is  57  per  cent.  (Avery, 
dickering,  Cole  and  Dochez). 

Type  III,  sometimes  called  Pneumococcus  mucosus  because  of  the 
stirky  exudate  which  it  forms,  is  highly  fatal.  The  mortality  is 
•  u>ly  place*!  from  50  to  100  per  cent.  This  group  is  responsible 
for  10  to  12  per  cent,  of  the  cases  of  pneumonia. 

Type  IV  embraces  strains  of  pneumococci  not  embraced  in  the 
above-mentioned  types.  About  25  per  cent,  of  cases  of  acute  lobar 
pneumonia  are  produced  by  this  type.  The  mortality  rate  is  placed 
at  about  10  per  cent.  Most  of  the  pneumococci  found  in  mouths 
during  health  belong  to  type  IV.  Of  450  normal  individuals  harboring 
pneumoconi  type  IV  claimed  345. 

Types  I  and  II  seldom  are  found  in  the  mouths  of  healthy  indi- 
vidual-. unle»  they  have  been  in  intimate  association  with  pneumonia 
of  lu»e  types.  Of  6S  lobar  pneumonia  recently  investigated 

at  the  Xaval  Hospital,  Chelsea,  Massachusetts,  13  were  due  to  type  I, 
type  II.  4  to  type  III.  j s  to  type  IV,  and  22  were  "not  typed." 

Identification  of  the  type  in  a  given  case  is  of  utmost  importance. 
If  the  disease £e  due  to  type  I,  a  serum  of  high  potency  prepared  from 
thi-  type  may  be  administered.  Of  103  cases  caused  by  type  I  the 
serum  treatment  at  the  Rockefeller  Institute  has  shown  but  eight 


402  NAVAL   HYGIENE 

deaths.  Serum  therapy  has  been  unsatisfactory  in  types  II,  III,  and 
IV. 

Mode  of  Transmission. — Pneumonia  is  a  sputum-borne  disease 
(droplet  infection).  It  seems  that  dried  sputum  readily  may  cause 
the  disease.  From  175  specimens  of  dust  from  houses  which  had  con- 
tained pneumonia  due  to  types  I  or  II,  73  specimens  showed  pneumo- 
cocci,  and  of  this  number  47  belonged  to  types  I  or  II  (Cole). 

Prevalence. — In  the  United  States  Navy  the  morbidity  rate  for 
pneumonia  in  1915  was  4.23  per  1000,  and  in  1916  was  3.82  per  1000. 

Immunity. — One  attack  does  not  confer  lasting  immunity  but 
predisposes  to  a  second  attack.  Immunization  by  means  of  sera  has 
been  disappointing.  It  is  possible  that  preventive  inoculation  may  be 
tried  among  troops  with  hope  of  success. 

Prophylaxis. — Careful  concurrent  and  terminal  disinfection  should 
be  practised.  Pneumonia  cases  should  be  isolated  and  treated  as  other 
infectious  diseases.  Particular  care  should  be  given  to  washing  the 
walls  and  floors  of  rooms  occupied  by  pneumonia  patients  with  dis- 
infecting solutions.  The  convalescents  must  be  regarded  as  healthy 
carriers  although  the  organisms  belonging  to  types  I  and  II  die  out  in 
their  mouths  within  a  few  weeks.  The  longest  period  in  which  the 
organisms  have  been  observed  to  persist  in  the  mouth  of  a  convalescent 
has  been  eighty-three  days.  Type  I  disappears  from  the  dust  within 
three  or  four  weeks. 

Disinfection  of  Pneumococcus  Carriers. — A  very,  Chickering,  Cole 
and  Dochez  found  12  per  cent,  of  healthy  persons  who  were  in  contact 
with  lobar  pneumonia  due  to  pneumococci  of  types  I  and  II  carried 
pneumococci  of  the  type  with  which  they  were  in  contact. 

The  same  observers  found  these  types  in  only  0.3  per  cent,  of 
healthy  persons  who  had  not  been  in  contact  with  lobar  pneumonia. 

Healthy  carriers  exist  as  well  as  convalescent  carriers.  (Convales- 
cents carry  the  bacilli  three  or  four  weeks.)  All  persons  in  contact 
with  lobar  pneumonia  and  all  convalescents  from  the  disease  should 
use  an  antiseptic  gargle  such  as  Dobell's  solution. 

Kolmer  and  Steinfield  recommend: 

Ethylhydrocuprein    hydrochloride 0-005 

Liquor    thymolis 5  .  ooo 

Aq.    Dist.    ad * .   50 .  ooo 

Quinine  bisulphate  or  quinine  hydrobromide  may  be  used  ir.  i  to 


INFECTIOUS   DISEASES  403 

10,000  dilution  with  good  result  The  ethylhydrocuprein  hydrochloride 
may  he  used  twice  daily  without  any  ill  effect  from  such  small  quantity 
as  might  be  swallowed  during  the  garble. 

TUBERCULOSIS 


Bacteriology. — The  tubercle  bacillus,  discovered  by  Koch  in  1882 
is  a  Gram -positive,  acid-fast  bacillus  3  microns  Jong  and  very  narrow. 

Tubercle  bacilli  produce  tuberculosis  in  man,  cattle,  birds-  and 
nsh.  The  bovine  type  may  produce  the  disease  in  man  and  the  human 
type  infects  cattle.  The  avian  and  the  fish  types  are  of  little  importance 
to  man.  Pulmonary  tuberculosis  in  man  usually  is  due  to  the  human 
type,  while  the  bovine  type  causes  many  of  the  glandular,  bone  and  skin 
lesions.  About  7  per  cent,  of  tuberculosis  in  man  is  of  the  bovine  type. 

The  average  admission  rate  for  tuberculosis  in  the  U.  S.  Navy 
ior  the  past  ten  years  has  been  4.89  per  1000.  For  the  past  three 
years  it  has  caused  a  greater  number  of  sick  days  than  any  other  disease, 
and  more  than  10  per  cent,  of  the  deaths  in  the  naval  service  are  due  to 
tuberculosis. 

Modes  of  Infection. — Three  principal  modes  of  infection  are 
recognized: 

(a)  The  ingestion  method; 

(b)  The  inhalation  method; 

(c)  The  droplet  method. 

(a)  The  ingestion  theory  has  the  support  of  most  investigators  who 
hold  that  infection  usually  occurs  early  in  life,  remains  latent,  and 
becomes  active  under  conditions  favorable  for  its  development.     The 
bacillus  may  be  carried  on  to  food  by  vermin  or  insects.     It  survives  in 
cool  water  for  a  year,  hence  infection  through  water  polluted  by  de- 
jecta or  sputa  of  persons  having  tuberculosis  may  be  a  factor.     Whether 
taken  with  food  or  as  dust  swallowed  the  primary  lesions  are  glandular 
and  a  suitable  exciting  cause  may  light  up  a  systemic  infection. 

(b)  The  inhalation  method  is  important  for  the  reasons  that  bacilli 
may  he  inhaled,   then  swallowed,  or  may  ultimately  reach  the  lungs 
l;y   inhalation.     The   bacillus   may   remain   alive  for  months  in  dried 
sputum  provided  sunlight  does  not  gain  access  to  and  disinfect  it. 

(c)  The  droplet  method  of  contact  infection  must  be  more  seriously 
considered  aboard  ship  than  it  is  ashore. 


404  NAVAL  HYGIENE 

Aboard  ship  the  contact  is  closer,  the  per  capita  air  volume  smaller, 
the  dilution  of  expired  air  is  less,  and  temperature,  moisture  and 
darkness  between  decks  favor  the  life  of  the  bacillus  which  is  sprayed 
into  the  air. 

Predisposing  Causes. — Youth,  hereditary  weakness,  overwork, 
exposure,  vicious  habits,  infectious  diseases,  respiratory  diseases,  and 
poverty  are  predisposing  causes.  Any  deviation  below  the  standard 
height  and  weight  for  age  should  excite  suspicion. 

Immunity. — Bitzke  of  Berlin  states  58  per  cent,  of  autopsies  show 
past  or  present  tuberculous  lesions.  This  is  the  lowest  estimate  made; 
other  observers  place  the  percentage  at  90  or  above. 

Accepting  58  per  cent,  of  all  autopsies  as  showing  tuberculosis 
and  remembering  that  12  per  cent,  of  the  German  people  die  of  tuber- 
culosis it  would  appear  that  46  per  cent,  of  those  who  die  must  possess 
considerable  immunity  to  tuberculosis,  else  they  would  have  succumbed 
to  the  infection  which  failed  to  cause  the  death. 

Probably  the  infections  early  in  life  produce  immunity.  Most 
persons  over  five  years  of  age  will  give  a  positive  Von  Pirquet  reaction. 

No  race  is  immune.  The  negro  race  appears  more  susceptible  than 
the  white,  but  the  greater  ignorance  and  poverty  among  negroes 
may  account  for  their  apparently  greater  susceptibility. 

Prophylaxis. — Reject  all  applicants  for  enlistment  who  present 
suspicious  physical  signs,  symptoms  or  history.  Accept  none  who 
fall  below  the  standards  of  weight  and  height  for  age. 

The  medical  officer  should  examine  any  of  the  crew  who  upon  in- 
spections appear  to  be  under  par. 

Members  of  the  crew  who  cough,  especially  at  night,  should  be 
located  and  examined.  Prolonged  "  colds  "  should  be  carefully  watched, 
the  sputum  being  examined  from  time  to  time. 

Early  Diagnosis  is  the  Keynote  of  Prophylaxis. — If  the  disease 
develops  aboard  ship  the  victim  should  be  isolated  (so  long  as  B. 
tuberculosis  is  being  given  off  by  him),  on  deck  if  the  weather  will 
permit,  and  sent  out  of  the  ship  at  the  earliest  possible  moment. 
His  mess  gear  should  not  be  used  by  others  and  should  be  boiled  after 
each  use.  His  sputum  should  be  received  in  paper  sputum  cups  or  in 
gauze  and  burned.  All  articles  soiled  by  sputum,  nasal  discharges 
or  feces  should  be  burned  or  disinfected.  He  should  be  cautioned 
concerning  danger  to  others.  After  his  transfer  from  the  ship  the 
space  occupied  by  him  should  be  thoroughly  disinfected. 


Associates  of  the  tuberculous  man  should  be  watched  carefully 
for  symptoms  of  infection. 

Anti-spitting  regulations  should  be  enforced  rigorously  aboard 
ship.  Men  should  be  taught  the  danger  of  spitting. 

Automatically  flushing  cuspidor-urinals  should  be  conveniently 
placed  for  access  by  the  crew. 

Everything  should  be  done  to  improve  the  health  and  increase  the 
resistance  of  the  crew. 

One  who  has  had  tuberculosis  should  never  be  permitted  to  return 
t  >  duty  aboard  ship. 

It  is  said  that  more  than  150,000  men  have  been  invalided  home  from 
t  ie  French  Army  (Biggs,  1916)  because  of  tuberculosis.  Our  own 
nu-n  serving  in  France  will  do  well  to  remember  that  the  tubercle  bacil- 
lus may  live  long  in  water  and  that  trench  infections  may  occur. 

MALARIA 

Malaria  is  caused  by  animal  parasites  belonging  to  the  Haemo- 
sporidia.  These  Haemamcebae  enter  the  red  cells,  produce  pigment, 
and  possess  amoeboid  movement. 

The  characteristic  paroxysms  of  malaria  are  due  to  the  rupture  of 
the  merocvte  in  the  blood,  the  toxin  producing  chill,  fever,  and  sweat. 

Tertian  malaria,  caused  by  Plasmodium  mvax,  is  so  called  because 
the  rupture  of  merocytes  of  this  organism  occurs  every  third  day. 

Quartan  malaria  is  caused  by  Plasmodium  malaria.  The  merocytes 
of  this  parasite  rupture  and  produce  malarial  paroxysms  every  fourth 

.  hence  the  name  "Quartan." 

Aestivo -autumnal  malaria  is  caused  by  Plasmodium  ialciparwn. 

Laveran  discovered  the  cause  of  malaria  and  Ross  discovered  that 
the  organism  is  transmitted  by  the  mosquito  (1895).  His  observa- 
tions have  received  fullest  confirmation. 

The  epoch-making  work  of  Theobald  Smith  had  bla/ed  the  trail 
fo -  the  work  of  \\< 

Smith    di-eovered    that    Texa-    fever   of   tattle   is  a   malarial-like 

db-ea-c   cau-ed  by  a  blood  parasite.     He  further  dist  n\ -ered  that  this 

1  ransmitted  by  the  cattle  tick  as  an  Intermediate  host. 

;  observations  laid  the  foundation  for  the  study  of  insect-borne 

diseases   and  for  the  brilliant  discoveries  which  have  followed. 


406  NAVAL   HYGIENE 

Transmission.— Malaria  is  transmitted  from  man  to  man  by  the 
Anophelinae,  a  sub-family  of  the  Culicidae.  At  least  25  per  cent,  of 
the  anopheline  mosquitoes  are  known  to  transmit  malaria. 

The  female  of  the  species  alone  is  capable  of  infecting  man.  She 
feeds  upon  blood  of  a  malarial  patient,  becomes  infected,  the  parasites 
develop  and  the  mosquito  after  a  lapse  of  twelve  days  becomes  capable 
of  infecting  man.  "The  parasite  will  not  develop  in  the  mosquito 
when  the  mean  temperature  is  below  6o°F."  (Rosenau). 

The  male  feeds  upon  plants,  fruits,  and  flowers.  The  Anophelinae 
are  large  brown  mosquitoes.  In  resting  position  they  assume  an 
attitude  which  places  their  long  axis  at  an  angle  of  45  degrees  to  the 
surface  on  which  it  stands.  Stitt  has  aptly  compared  it  to  a  bradawl. 

Both  sexes  have  palpi  as  long  or  longer  than  the  proboscis. 

The  Anophelinae  breed  in  pools  or  stagnant  water,  are  nocturnal 
feeders,  and  live  in  the  open  rather  than  in  houses. 

Immunity. — Individuals  may  carry  a  malarial  infection  without 
showing  symptoms  until  concurrent  illness,  injury,  or  lowering  of 
resistance  enables  the  development  of  paroxysms. 

It  is  not  uncommon  in  the  naval  service  to  see  an  individual  infected 
in  the  tropics  and  "cured"  develop  malaria  upon  reaching  a  cooler 
climate.  One  attack  of  malaria  predisposes  to  another. 

Prophylaxis. — In  malarial  districts  ships  lying  alongside  the  dock 
should  be  screened.  This  seems  next  to  impossible,  but  the  writer 
has  seen  it  efficiently  done  on  a  dreadnaught  battleship. 

Screens  should  be  made  of  copper  wire  cloth  eighteen  strands  to  the 
inch.  This  reduces  the  actual  area  of  any  screened  opening  by  33^ 
per  cent,  but  the  reduction  in  fresh-air  intake  is  compensated  for  by 
increased  comfort  and  safety. 

If  the  ship  lies  a  mile  from  the  shore  she  is  apt  to  remain  free  of 
mosquitoes,  except  such  as  come  on  the  clothing  and  the  market  boats 
or  bumboats. 

If  the  ship's  battalion  must  land  each  man  should  carry  his  mos- 
quito net  and  use  it.  In  addition,  if  in  the  face  of  an  enemy,  or  if  the 
landing  is  only  for  a  very  brief  time,  5  grains  of  quinine  per  day  should 
be  given  to  each  man. 

This  practice  has  the  disadvantage  of  masking  a  possible  infection 
and  making  its  diagnosis  difficult. 

A  camp  should  be  established  to  windward  of  marshes  where 
mosquitoes  breed,  and  away  from  collections  of  infected  natives. 


INFECTIOUS   DISEASES 


407 


Fu,.    134. — Anopheles     macidipennis  FIG.      135. — Aedes     calopus,      male 

(quadrimaculatus),ma\e.  (After  Castellani       (Stegomyia     calopus).        From      P.     H. 
and  Chalmers.)      From  P.  H.  Reports.  Reports. 


Fi'  nnnulipi-nni^        FK..    137. — A  edes  calopus,  female  <  x 

(quudrimmulalus),    female.     {(Castellani         (myia  calopus).     From  P.  H.  Reports. 
</>?</    Chalmers,   after  Austen.)      From  P. 
H.  Reports. 


408 


NAVAL   HYGIENE 


If  a  site  is  to  be  occupied  sufficiently  long  to  warrant  it  the  area  should 
be  drained  to  prevent  mosquitoes  breeding. 

Tin  cans  and  old  bottles  should  be  buried.  No  unscreened  con- 
tainers should  be  allowed  to  hold  water.  Sagging  gutters  should  be 
lined  up  or  punctured  at  the  most  dependent  point  so  water  cannot 
stand  in  them. 

In  the  tropics  bamboo  posts  are  used  for  fences.  The  cups  left  on 
top  of  these  posts  as  result  of  cutting  between  the  joints  may  furnish 
unnoticed  breeding  places  right  under  one's  nose.  Cavities  in  forks  of 
trees  or  as  result  of  decay  of  trees  should  be  filled  with  cement,  or  with 
earth.  Trees  should  be  cleared  away  as  much  as  possible. 

Commonly  in  the  tropics  the  legs  of  a  cupboard  or  ice  box  are 
placed  in  basins  of  water  to  prevent  ants  from  having  access  to  food. 


1  Z  3 

FlG.   138. — Resting  posture  of  mosquitoes:  I  and  2,  Anopheles]  3.  Culex  pipiens. 
(After  Sambon.)     From  P.  H.  Reports. 

The  writer  has  found  mosquitoes  breeding  freely  in  such  basins  inside 
a  thoroughly  screened  house. 

Personal  Prophylaxis. — Unnecessary  exposure  at  night  on  shore 
should  be  avoided  in  malarial  districts.  Gloves  should  be  worn.  Sen- 
tries should  be  supplied  with  head  nets.  Screened  sentry  boxes 
should  be  used  when  practicable.  The  writer  has  seen  them  prove  a 
godsend  in  one  instance.  The  ankles  should  be  protected  by  high 
shoes  and  leggins. 

Men  should  sleep  under  mosquito  nets.  The  nets  should  be  well 
tucked  in  all  around  the  cot  to  keep  mosquitoes  out. 

The  watch  should  be  instructed  to  see  that  sleeping  men  have  not 
thrust  an  arm  or  leg  up  against  the  net  where  a  mosquito  may  alight 
and  thrust  a  hungry  proboscis  through  the  net. 

Volatile  oils,  e.g.,  citronella,  pennyroyal,  lavender,  and  the  like 
serve  temporarily  to  repel  the  mosquito.  Smudges  may  be  burned 
about  a  camp  as  repellants.  The  insecticidal  fumigants  (sulphur, 


INFECTIOUS    DISEASES 


409 


hydrocyanic  acid)  may  be  used  in  enclosed  houses  to  kill  the  insects. 
Pyrethrum  is  little  better  than  useless.     It  is  not  insecticidal,  but 
does    intoxicate    the   insects    temporarily.     All    ditches,    drains   and 
>ools  should  be  sprinkled  weekly  with  crude  oil. 

TYPHOID  FEVER 

Typhoid  fever  is  an  acute,  communicable  disease  resulting  from 
\>temic  invasion  by  Bacillus  typhosus.  Typhoid  fever  has  been 
a  scourge  of  military  and  naval  forces,  especially  in  war  time,  until 
within  the  past  ten  years,  when  the  prophylactic  inoculations,  which  are 
now  compulsory  in  the  U.  S.  Army  and  Navy,  have  practically  abolished 
this  disease  among  military  and  naval  forces  employing  the  prophy- 
lactic. 

Bacteriology. — Bacillus  typhosus  is  a  Gram -negative,  actively 
motile,  short,  thick,  flagellated  bacillus. 

It  does  not  coagulate  milk  and  produces  no  gas  in  lactose  or  glucose 
bouillon.  Neutral  red  is  not  reduced. 

B.  typhosus  invades  the  body  through  the  mouth  and  appears  to 
enter  the  blood  through  the  tonsil  or  lymphoid  structure  elsewhere 
along  the  alimentary  tract. 

It  may  appear  in  the  feces  before  the  fever  commences,  and  may  be 
cultured  from  the  urine  in  the  second,  third  or  fourth  week.  It  appears 
in  the  cultures  from  the  blood  in  90  per  cent,  of  the  cases  (Kayser) 
during  the  first  week. 

Urine  and  feces  should  be  plated  out  upon  Endo's  medium.  This 
method  gives  best  results,  if  blood  culture  is  negative,  and  is  without 
equal  in  search  for  carriers. 

Like  other  filth  diseases,  typhoid  fever  is  conveyed  in  food  and 
drink  which  has  become  polluted  by  the  excreta  or  secretions  of  persons 
afflicted  with  the  disease  or  of  individuals  who  have  suffered  from  the 
disea>e,  have  recovered,  and  are  healthy  carriers  capable  of  transmitting 
the  affection  to  others.  It  is  estimated  that  25  per  cent,  of  healthy 
carriers  have  never  had  a  recognized  attack  of  typhoid  fever.  The 
crowded  conditions  which  prevail  on  board  ship  are  very  favorable 
for  the  transfer  of  tilth  diseases. 

Prophylaxis.  The  following  statistics  taken  from  the  annual  re- 
port of  the  Surgeon  General,  IL  S.  Navy,  1917,  show  the  number  of 
admissions  and  deaths  from  this  disease  during  the  past  seventeen 


4io 


NAVAL  HYGIENE 


STATISTICS    ON    TYPHOID    FEVER    FROM    1900    TO    1916,    INCLUSIVE,    GIVING 
ADMISSIONS,   DEATHS,  AND  COMMENT  ON  DEATHS  SINCE  PROPHYLAXIS  BEGAN 

IN  (FEBRUARY) 1912 


Year 

Admis- 
sions 

Deaths 

Year 

Admis- 
sions 

Deaths 

IQOO. 

I7C 

2"? 

1909  

IQI 

16 

IOOI 

ICK 

14 

IQIO  . 

I  O4 

I9O2 

I  2  C 

1  3 

IQII 

222 

T  C 

I  GO? 

1  88 

2O 

IQI21..  . 

cy 

2 

IOO4. 

104. 

10 

IQI22. 

2  2 

1905  
1906 

172 
23O 

IO 
14 

1914. 
IQI?3.  • 

13 

18 

I 

o 

IOO7 

24.O 

16 

1016 

17 

o 

1908 

176 

IO 

From  the  practical  viewpoint  compulsory  inoculation  has  almost 
completely  abolished  this  disease.  The  immunity  appears  to  decrease 
about  50  per  cent,  during  the  first  year  after  the  inoculation,  and  at 
the  end  of  the  second  year  is  practically  nil. 

All  persons  should  receive  the  prophylactic  upon  appointment  or 
enlistment  in  the  naval  service.  The  inoculation  should  be  repeated 
each  successive  enlistment.  Those  past  forty-five  years  of  age  may  be 
exempted,  as  may  those  whose  official  health  records  give  history  of  a 
bona  fide  attack  of  typhoid.  Troops  operating  in  the  field  should 
have  compulsory  inoculation  once  every  two  years. 

Formerly  the  prophylactic  was  specific  for  typhoid  fever  alone. 
Those  immunized  by  it  remained  susceptible  to  paratyphoid  whether 
caused  by  Bacillus  paratyphosus  "A"  or  "B."  Recently  the  U.  S. 
Army  and  Navy  have  adopted  a  mixed  emulsion  called  "The  Triple 
Vaccine."  It  takes  its  name  from  the  fact  that  it  is  made  from  killed 
broth  cultures  of  Bacillus  typhosus,  Bacillus  paratyphosus  "A" 
and  Bacillus  paratyphosus  "  B"  Immunization  against  these  three 
organisms  may  be  effected  by  the  use  of  "Triple  Vaccine,"  whereas 

1  Prophylaxis  began  in  February  of  this  year.     Of  the  deaths  one  was  a  case 
that  had  received  no  prophylactic  treatment. 

2  Of  the  four  deaths  only  one  case  had  received  the  full  protective  treatment. 
One  had  received  none.     Two  cases  had  had  only  the  first  injection. 

3  All  injections  given. 

Compulsory  prophylactic  injections  were  begun  in  February,  1912.  During 
1912  and  the  subsequent  four  years  there  have  been  only  seven  deaths  in  the  Navy 
from  typhoid  fever.  For  1915  and  1916  there  were  no  deaths. 


INFECTIOUS    DISEASES  411 

the  emulsion  of  dead  typhoid  bacilli  formerly  used  afforded  protection 
against  typhoid  alone.  The  results  obtained  after  the  use  of  the  "  Triple 
Vaccine"  have  been  gratifying. 

The  prophylactic  inoculation  as  practised  in  the  U.  S.  Navy  consists 
in  the  administration  of  three  hypodermic  injections  of  an  emulsion 
of  dead  typhoid  bacilli  and  dead  paratyphoid  bacilli  "A"  and  "B," 
i.e.,  killed  broth  cultures.  The  first  injection,  0.5  c.c.,  contains  five 
hundred  million  dead  organisms.  The  second  dose,  given  ten  days 
Liter,  contains  one  billion  organisms,  and  the  last  dose  given  after  an- 
other ten-day  interval  also  contains  one  billion  dead  organisms. 

The  site  of  the  injections  commonly  has  been  at  the  insertion  of  the 
deltoid  muscle.  This  site  is  exposed  to  injury  during  the  day,  and  dur- 
ing the  night  the  tender  arm  may  be  rolled  upon.  It  is  recommended 
that  the  injections  be  given  subcutaneously  in  the  infraclavicular 
ion.  The  site  should  be  painted  with  tincture  of  iodine  before  and 
ter  the  injection,  which  should  be  placed  sufficiently  near  to  the  mid- 
e  of  the  thorax  to  avoid  pressure  which  would  result  from  the  wear- 
of  suspenders.  The  injections  should  be  subcutaneous,  not  intra- 
scular.  Severe  reactions  have  followed  the  rapid  absorption  conse- 
ent  upon  injection  of  the  prophylactic  into  muscle.  It  is  dangerous. 
The  hypodermic  syringe  should  be  thoroughly  sterilized  before 
ing  used.  For  this  purpose  Lelean  recommends  drawing  into  the 
rrel  oil  heated  to  i3o°C.  The  barrel  should  be  allowed  to  cool  before 
ing  with  the  emulsion,  else  the  potency  of  the  emulsion  maybe  dimin- 
ed  or  lost. 

Patients  having  fever  or  other  evidence  of  indisposition  should  not 
inoculated.     There  is  no  contraindication  to  the  administration 
the  anti-typhoid  vaccine  and  vaccination  against  smallpox  at  the 
e   time.     After  administration   of   the  anti-typhoid  prophylactic 
individual  should  not  indulge  in  alcoholic  drink  or  much  physical 
tifle.      L'.xperience  has  shown  it  is  best  to  give  the  injections  in  the 
ternoon  after  4  o'clock.     By  doing  this  the  resulting  reaction  occurs 
ring  the  night,  generally  is  over  by  morning,  and  interferes  little 
ith  i-ither  the  patient's  sleep  or  his  activities  on  the  following  day.     A 
ere  reaction  is  met  in  about  i  per  cent,  of  the  cases.     A  slightly 
ter  percentage   will   require  to  be  excused   the  day   following  the 
ulation,  but  the  large  majority  will  be  tit  for  duty  on  the  morning 
flowing  inoculation. 
Despite  the  wonderful  results  which  have  been  achieved  by  prophy- 


412  NAVAL   HYGIENE 

lactic  inoculations  other  efforts  at  prophylaxis  should  not  be  relaxed, 
for  even  in  units  where  complete  compulsory  prophylaxis  has  been 
practised  some  susceptible  individual  may  be  found. 

Drinking-water  supplies  should  be  safeguarded  against  pollution 
and  milk  should  be  pasteurized,  raw  oysters  should  not  be  served,  and 
raw  vegetables,  such  as  water  cress  from  suspicious  sources,  should  not 
be  used  as  food,  especially  by  a  military  unit  such  as  a  battleship's  crew. 

Medical  officers  should  instruct  the  crew  to  wash  their  hands  after 
defecation  or  urination  and  before  each  meal. 

Those  connected  with  the  cooking  and  serving  of  food  should  be 
examined  with  a  view  to  eliminate  typhoid  carriers. 

If  typhoid  fever  is  suspected  the  patient  should  be  isolated  at  once 
in  a  room  screened  against  flies.  A  positive  Widal  reaction  is  of  little 
diagnostic  value  as  it  will  be  found  .in  nearly  all  persons  who  have 
received  the  anti- typhoid  inoculation.  A  blood  culture  should  be  taken 
at  the  earliest  possible  moment  with  a  view  to  establish  definite  diag- 
nosis. Visitors  should  be  prohibited.  Mess  gear  should  be  boiled  after 
each  meal,  special  care  being  given  to  the  destruction  or  disinfection  of 
food  left  by  the  patient  after  meals.  It  should  not  be  left  where  it  may 
be  eaten  by  others.  All  linen  and  bedding  should  be  thoroughly  dis- 
infected, as  should  the  patient's  clothing.  The  dejecta  should  be 
thoroughly  disinfected  with  chlorinated  lime,  with  5  per  cent,  carbolic 
acid  solution,  or  destroyed  by  burning  or  boiling.  The  patient's 
bath  water  should  be  disinfected  before  it  is  permitted  to  enter  the 
drain  pipes  of  the  ship  or  the  sewer. 

Should  a  patient  be  so  unfortunate  as  to  have  an  abscess  or  bed 
sores  the  dressings  should  be  destroyed  by  burning.  Gauze  or  paper 
handkerchiefs  should  be  used  by  the  patient  and  burned  after  use. 
Ice  bags  and  any  other  articles  used  in  the  treatment  should  be  thor- 
oughly disinfected  after  each  use. 

Newspapers,  magazines  or  any  other  articles  handled  by  the  patient 
should  be  disinfected  or  destroyed. 

Upon  convalescence  the  patient  should  not  be  liberated  from  quaran- 
tine for  duty  among  fighting  units  until  laboratory  examinations  have 
shown  that  typhoid  bacilli  are  no  longer  found  in  the  urine  and  feces. 

ANCYLOSTOMIASIS 

Ancylostomiasis  is  a  widespread  disease  in  the  tropics  and  sub- 
tropics,  due  to: 


INFECTIOUS    DISEASE 


413 


\  -  <dtor  inner  ifii  ii  its: 
(b)   .  1  ncylostoma  diwdcnalc. 

The  former  is  the  cause  of  the  infection  common  in  the  United 
ites,  while  the  latter  is  called  the  Old  World  species  because  it  is  the 
usually  found  outside  the  United  States. 


70*40 ft 


FK;.   139. — la,  Copulatory  bursa  of  Necator  americanus,  showing  the  deep  cleft 
iviiling  the  branches  of  the  dorsal  ray  and  the  bipartite  tips  of  the  branches;  also 
hrnving  the  fusion  of  the  spicules  to  terminate  in  a  single  barb.     Scale  i/io  mm. 
Branches  of  dorsal  ray  magnified.     2a,  The  buccal  capsule  of  N.  americanus. 
The  same  magnified.     3a,  Copulatory  bursa  of  Ancylostoma  duodenale,  showing 
>v  clefts  between  branches  of  the  dorsal  ray  and  the  tridigitate  terminations. 
Spicules  hair-like,     ab,  The  dorsal  ray  mannifk-d.     4a,  The  buccal  capsule  of  A. 
".<ilf.  showing  the  much  larger  mouth  opening  and  the  prominent  hook-like 
ventral  teeth.     4b,  The  same  magnified.     5a,  Egg  of  N.  americanus.     $b,  Egg  of 
A.  dnn,i,-nnl,-.     '>a.  Rhabditiform  larva  of   5  <les  as  seen  in  fresh  faeces.     6b, 

Rhabditiform  larva  of  hookworm  in  fasces  eight  to  twelve  hours  after  passage  of 
in.) 

The  females  arc  '  •>  inch  long  and  have  a  pointed  tail.  The  males 
1  ;i  inch  in  length  and  the  tail  is  expanded  somewhat  like  an 
umbrella. 

Both  spirit  infei't  and  atkrt  man  alike.  Diagnosis,  treatment  and 
p'ophylaxi-  are  similar  for  the  two  species. 


414  NAVAL   HYGIENE 

Life  History. — The  female  is  extremely  fertile.  She  lays  an  enor- 
mous number  of  eggs  as  she  hangs  to  the  mucous  surface  of  the  human 
intestine.  The  eggs  escape  with  the  feces  of  the  host.  If  the  climate 
is  warm  or  if  the  feces  are  deposited  in  tunnels  or  mines  where  there  is 
the  moisture  and  warmth  necessary  to  development  of  the  ova,  they 
soon  (in  twenty-four  hours)  are  ruptured  by  the  mature  embryos,  or 
larvae. 

The  larvae  live  in  the  soil  and  bore  into  the  human  skin  with  which 
they  may  come  into  contact  (90  per  cent,  of  infections  occur  thus,  the 
remainder  enter  by  the  mouth).  Within  the  body  the  larvae  makt 
their  way  ultimately  to  the  jejunum  of  the  host  and  commence  repro- 
duction of  kind,  by  copulation  and  oviposition. 

Prevalence  in  the  Navy. — Of  3500  recruits  from  Southern  State 
examined  for  hook  worm,  n  per  cent,  were  found  infected.  Especia 
precautions  must  be  taken  to  prevent  infection  of  soil  by  these  carriers 

Prophylaxis. — Detect  and  treat  carriers.  Prevent  pollution  of  foo« 
and  drink  by  feces.  Dispose  of  feces  in  sanitary  manner.  Wear  shoe 
and  gloves  if  contact  with  infected  soil  is  necessary. 

DYSENTERY 

The  symptom  complex  called  dysentery  may  be  of  bacillary  c 
amoebic  origin. 

The  bacillary  type  is  caused  by  the  Bacillus  dysenteries,  an  orgai 
ism  which  resembles  B.  typhosus  in  most  respects  except  motilit? 
It  is  non-motile. 

Two  strains  of  B.  dysenteries  are  recognized: 

(a)  The  Shiga-Kruse  type; 

(b)  The  Flexner-Strong  type. 

The  former  does  not  develop  acid  in  mannite,  while  the  latter  doe 
The  Shiga  type  is  the  more  toxic. 

Prevalence. — Bacillary  dysentery  may  appear  in  epidemic  form 
the  tropical  or  temperate  zones.  The  writer's  observation  of  tl 
disease  in  Japan  has  impressed  its  fatality  and  ease  of  spread  in  a  tei 
perate  climate.  Bacillary  dysentery  is  especially  to  be  feared  amoi 
troops  or  massed  men.  It  spreads  rapidly. 

Immunity. — One  attack  appears  to  confer  no  lasting  immunit 
Vaccination  has  proved  unsatisfactory  owing  to  the  severe  reactio 


INFECTIOUS   DISEASES  415 

after  administration  of  killed  cultures  of  B.  dysenteries.  A  curative 
serum  is  used. 

Amoebic  Dysentery. — Amoebic  dysentery  is  caused  by  the  En- 
damceba  histolytica,  an  animal  parasite  which  is  distributed  through- 
out the  entire  tropical  and  sub-tropical  world. 

The  parasite  enters  the  body  through  the  mouth,  while  in  the  en- 
cysted stage  of  its  life  history,  and  produces  dysenteric  symptoms. 

Walker  and  Sellards  have  shown  that  cultural  amoebae,  i.e.,  vege- 
tative forms,  are  incapable  of  producing  the  disease. 

Prophylaxis. — Both  forms  of  dysentery  may  be  prevented  by  disin- 
ection  of  the  alvine  discharges  of  a  patient.  Disinfection  of  toilets, 
bedpans,  rectal  tubes,  linen,  bedding,  buttocks  of  patients,  and  hands 
of  attendants  are  all  necessary. 

In  presence  of  an  outbreak  the  carriers  of  encysted  Endamceba 
histolytica  or  of  B.  dysenteries  should  be  isolated  and  treated. 

The  hands  always  should  be  washed  before  meals,  but  special  atten- 
ion  should  be  paid  to  this  during  an  outbreak.  Food  and  drink  should 

above  suspicion,  and  should  be  protected  from  flies. 

Wards,  latrines,  water  closets,  etc.,  should  be  screened  against  flies. 

TAPEWORMS 

Certain  of  the  cestodes  are  parasitic  for  man  and  are  occasionally 
let  in  the  naval  service.     Those  infecting  man  are  ribbon-shaped 
forms,  some  of  them  quite  long  and  consisting  of  a  scolex  or  head 
ind   proglottides   or   segments.     These    tapeworms   are    the   matured 
irval  forms  of  animal  parasites  which  begin  life  in  the  lower  animals. 
rhen  the  eggs  are  passed  from  the  bowel  they  gain  entrance  in  some 
lanner  or  other  to  the  alimentary  canal  and  circulation  of  animals 
used  as  food  by  man.     After  getting  into  the  circulation  the  egg  reaches 
the  muscles  or  viscera  and  there  forms  a  new  scolex  or  tapeworm 
head,  and  if  man  takes  one  of  these  heads  into  his  stomach  in  meat 
which  has  been  incompletely  cooked  the  scolex  there  develops  in  the 
stomach  into  the  tapeworm.     This  development  takes  place  by  the 
growth  of  segments  or  proglottides  which  grow  from  the  head.     There 
are  three  forms  of  tapeworm  which  develop  in  man. 

i.  Taenia  Saginata. — This  tapeworm  gains  entrance  to  man 
through  eating  rare  or  raw  beef.  It  is  the  "beef  tapeworm."  It 
is  the  most  common  in  the  United  States,  grows  from  12  to  30 


NAVAL   HYGIENE 


feet   long,    its  scolex  is  unarmed,  and  the  proglottides  crawl;  conse- 
quently may  be  mistaken  for  separate  worms. 

2.  Taenia  Solium,  or  Hog  Tapeworm.— This  is  a  smaller  tapeworm, 
from  6  to  12  feet  in  length.  Man  usually  is  infected  by  it  through 
the  ingestion  of  rare  or  raw  pork.  The  scolex  has  four  suckers  and 
26  hooklets,  long  and  short.  Because  of  these  hooklets  it  is  called 
the  "armed"  tapeworm.  It  is  not  so  common  in  this  country  as  in 
Europe. 


DibothriocephaliAi    latus 


Taenia    solium 


Taenia    saginata 


FIG.   140. — Adult  and  larval  stages  of  cestoda  of  man.     (From  Stilt.) 

3.  Dibothriocephalus  Latus. — This  tapeworm  is  rare  in  the  United 
States,  but  common  in  northern  Europe,  especially  among  fish-eating 
population.  Man  is  infected  through  the  eating  of  raw  or  rare  fish. 
This  is  the  largest  tapeworm  which  infects  man,  and  grows  from  18 
to  32  feet  in  length.  The  scolex  is  unarmed  and  has  two  grooves 
which  act  as  suckers. 

Prophylaxis. — Prophylaxis  against  tapeworms  consists  in  eating 
thoroughly  cooked  meat  and  drinking  pure  water. 


INFECTIOUS   DISEASES  417 

Occasionally  the  Taenia  echinococcus  or  the  dog  tapeworm  infects 
man.  This  is  a  very  small  tapeworm,  being  only  '5  to  }  • \  of  an 
inch  in  length  (4  to  9  millimeters).  When  the  ova  gain  entrance 
to  man's  circulation  they  form  a  cyst  containing  a  scolex  which  has 
30  or  40  hooklets.  Depending  upon  the  part  of  the  body  attacked 
wi.l  be  the  effect  of  the  growth  of  these  cysts.  Usually  the  infection 
is  very  serious.  This  parasite  is  rare  in  the  United  States. 

Prophylaxis. — Persons  having  dogs,  or  caring  for  dogs,  should  be 
very  careful  to  wash  the  hands  before  eating  and  to  avoid  drinking 
polluted  water. 

CHOLERA 

Cholera  is  an  acute  gastro-enteritis  produced  by  the  Spirillum 
asiaticce  cholera. 

The  disease  is  transmitted  by: 

1.  Carriers; 

2.  Infected  food; 

3.  Infected  water. 

Incubation. — The  period  of  incubation  seldom  is  over  five  days. 

Immunity. — One  attack  confers  no  lasting  immunity.  Vaccination 
appears  useless. 

Prophylaxis. — Isolate  sick  and  carriers.  Sterilize  all  food  and 
all  water  and  protect  both  from  flies  and  vermin.  Attendants  should 
wear  gowns  and  should  disinfect  vomitus,  dejections,  linen,  mess  gear 
and  everything  that  may  have  been  soiled  by  dejections  or  vomitus. 
Their  hands  should  be  thoroughly  disinfected.  They  should  not  eat 
in  the  sick  rooms.  Upon  recovery  or  death  of  the  patient  the  room 
should  be  disinfected  by  uMng  some  strong  disinfectant  solution  such 
as  5  per  cent,  carbolic  acid,  chlorinated  lime,  i  pound  to  4  gallons, 
i  to  500  bichloride  of  mercury  or  3  per  cent,  compound  cresol  solu- 
tion. The  tloor  furniture  and  walls  should  be  washed  with  this  solution. 

Fumigation  is  unnecessary  except  for  the  killing  of  flies  or  other 
^•e-min  which  may  have  been  infected. 

The  intimate  contact  of  our  men  in  the  war  zone  with  troops  from 
countries  where  cholera  is  endemic,  causes  the  disease  to  assume  far 
more  importance  than  hitherto  it  has  possessed  for  us. 


41 8  NAVAL  HYGIENE 

YELLOW  FEVER 

Yellow  fever  is  a  disease  of  unknown  cause,  found  in  tropical  and 
sub-tropical  countries,  and  transmitted  by  an  infected  mosquito, 
Stegomyia  calopus.  It  is  not  transmitted  by  fomites.  The  disease 
often  concerns  the  naval  medical  officer. 

The  discovery  of  the  mode  of  transmission  was  made  by  Reed, 
Carroll,  Agramonte  and  Lazear,  who  constituted  a  board  of  U.  S.  Army 
medical  officers  appointed  to  study  yellow  fever  in  1900-02. 

While  the  cause  of  yellow  fever  remains  undiscovered  the  brilliant 
discovery  of  the  mode  of  transmission  has  enabled  complete  control 
of  the  disease. 

Stegomyia  Calopus. — Stegomyia  calopus  is  a  blackish-brown 
mosquito  of  average  size  which  has  bright  silvery  bands  on  abdomen, 
thorax,  legs,  and  palpi.  The  dorsal  surface  of  the  thorax  is  marked 
with  the  lyre-shaped  silver  marking,  which  readily  identifies  the  insect. 
This  lyre  is  composed  of  two  parallel  silvery  lines  lying  in  an  antero- 
posterior  direction,  and  on  each  side  of  these  is  a  curved  silvery  line 
which,  as  it  extends  backward,  finally  becomes  prolonged  parallel 
to  the  two  parallel  lines  above  mentioned. 

The  female  transmits  yellow  fever.  The  male  is  not  a  blood  sucker. 
When  the  female  feeds  upon  an  infected  person  during  the  first  three 
days  of  his  disease  she  becomes  infected,  but  the  infection  requires 
twelve  days  in  which  to  develop  before  she  is  capable  of  transmitting 
her  disease  to  man. 

This  mosquito  lives  and  breeds  about  houses  wherever  conditions 
are  favorable  and  does  not  go  far  from  its  breeding  place.  It  feeds 
principally  in  the  day  time.  This  rule  is  not  invariable.  I  have  been 
bitten  by  Stegomyia  calopus  at  night. 

Except  as  borne  by  wind  Stegomyia  calopus  seldom  travels  a 
great  distance.  Ships  at  anchor  1000  feet  off  shore  are  safe  in  so  far 
as  Stegoymia  calopus  flying  to  them  is  concerned.  The  mosquito 
may  come  in  bumboats  or  be  driven  far  by  wind  from  shore. 

Period  of  incubation  is  two  to  five  days. 

Immunity. — No  race  is  immune.  One  attack  of  yellow  fever  confers 
lasting  immunity.  Two  attacks  in  the  same  individual  are  almost 
unknown. 

Prevention. — The  anti-mosquito  measures  described  under  malaria 
(see  page  406)  will  prevent  the  spread  of  yellow  fever.  In  the  tropics 


INFECTIOUS    DISEASES  419 

all  persons  who  develop  fever  should  be  placed  under  mosquito  net  at 
once  in  order  to  avoid  infecting  mosquitoes  with  possible  mosquito- 
borne  disease  and  its  consequent  transmission  to  man. 

DENGUE 

Dengue,  often  met  in  tropics  and  sub-tropical  countries,  is  undoubt- 
edly communicated  by  some  flying  insect,  although  its  specific  cause 
is  unknown.  Culex  fatigans  and  Culex  pipiens  have  been  suspected 
of  transmitting  it. 

Extensive  experiments  have  failed  to  prove  conclusively  that  either 
is  the  carrier. 

Craig  and  Ashburn  considered  Culex  fatigans  as  the  transmitter. 
Recent  work  in  Australia  points  toward  Stegomyia.  Dengue  does 
not  appear  contagious.  Medical  Director  R.  C.  Persons,  U.  S.  Navy, 
reported  that  24  men  went  on  liberty  from  the  U.  S.  S.  Baltimore 
a.  Cavite,  P.  I.,  and  although  20  of  these  men  were  taken  with  dengue, 
no  case  of  the  disease  developed  among  the  men  who  stayed  aboard. 
The  writer  repeatedly  has  treated  dengue  without  contracting  it. 

Period  of  incubation  is  two  to  nine  days.     The  virus  is  filterable. 

Immunity. — An  attack  of  dengue  confers  no  lasting  immunity. 
Repeated  attacks  occur  in  the  same  individual. 

Prevention. — The  locality  of  infection  should  be  avoided.  The 
patient  should  be  screened.  Until  more  accurate  knowledge  concerning 
the  cause  and  mode  of  transmission  of  dengue,  prophylactic  measures 
should  be  directed  against  the  blood-sucking  insects,  especially 
mosquitoes. 

PLAGUE 

Plague  is  caused  by  Bacillus  pestis.  The  disease  appears  in  three 
forms: 

(a)  Pneumonic; 

(b)  Bubonic; 

(c)  Septicaemic. 

Mode  of  Transmission. — The  pneumonic  type  is  conveyed  by  spu- 
tum, or  the  droplet  method.  The  bubonic  and  septicaemic  forms  are 
regarded  as  infectious  only  through  certain  fleas  and  possibly  bed 
bugs.  Xenopsylla  chcopis  (the  common  rat  flea  of  the  Orient),  and 


42O  NAVAL   HYGIENE 

Ceratophyllus  fasciatus  (the  common  rat  flea  in  the  United  States), 
transfer  this  disease  of  rodents  to  man. 

McCoy  studied  plague  in  California  where  it  has  been  found  that 
ground  squirrels,  rats,  and  possibly  other  vermin  carry  the  disease  and 
transmit  it  to  man  through  fleas. 

Immunity/ — One  attack  confers  lasting  immunity.  Haffkine's 
prophylactic  is  said  to  reduce  the  probability  of  infection  four-fifths 
(Martin)  and  recovery  is  two  and  one-half  times  as  frequent  among  the 
vaccinated  as  among  the  unvaccinated. 

Prophylaxis/ — Avoid  infected  localities.  Take  every  precaution 
against  flea  bites.  Pneumonic  plague  is  very  infectious  and  very 
fatal.  I  have  seen  death  occur  very  rapidly  in  this  type.  Physicians 


FIG.   141. — Types  of  rat  guards  placed  upon  the  mooring  lines  of  a  ship  to  prevent 
rats  coming  aboard  over  the  hawsers. 


attending  plague  should  wear  as  a  head-covering  an  inverted  closely 
woven  muslin  bag  which  should  come  down  over  the  neck  to  the 
shoulders  so  it  may  be  tucked  inside  the  collar  of  the  long  gown  which 
also  should  be  worn. 

The  above-described  head-gear  should  have  glass  goggles  in  it. 
Long  leggins  covering  the  shoes  entirely  and  extending  up  to  the  thighs 
should  be  worn.  These  leggins  may  well  be  saturated  with  kerosene 
or  other  flea  repellent.  Since  rodents  are  reservoirs  of  the  disease  and 
transmit  it  to  man  through  fleas,  every  precaution  should  be  taken 
to  keep  rats  off  ships. 

Rats  may  swim  a  half  to  three-quarters  of  a  mile,  hence  in  infected 


INFECTIOUS    DISEASES  421 

p»orts  they  may  bring  infection  aboard  by  swimming  to  the  anchor 
chain  and  coming  in  through  an  unprotected  hawse-pipe. 

When  ships  are  alongside  the  dock  the  mooring  lines  should  be 
tarred  or  protected  with  rat  guards  in  the  shape  of  inverted  funnels 
or  circular  tin  guards  to  prevent  rats  coming  aboard. 

The  gang-plank  should  be  triced  up  at  night,  and  during  the  day 
a  man  should  be  stationed  at  it  to  prevent  rats  reaching  the  ship  by 
this  route. 

Ships  entering  plague-infected  ports  should  be  fumigated  against 
vermin  once  every  six  months  as  a  routine  measure.  The  period  of 
detention  of  ships  from  plague-infected  ports  is  seven  days. 

TRENCH  FEVER 

ench  fever  or  Volhynian  fever  is  a  communicable  disease,  probably 
due  to  specific  infection,  the  cause  of  which  is  at  present  unknown. 

Etiology. — Observers  have  reported  discovering  organisms  in  the 
blood  or  urine  of  those  suffering  with  trench  fever,  but  neither  the  micro- 
scope nor  ultra-microscope  has  discovered  the  specific  cause.  Sergent 
found  semilunar  bodies  in  the  blood.  Houston  and  McCloy  isolated 
a,  coccus  from  the  urine.  Pappenheimer  found  discoid  bodies  in  the 
blood,  and  Patterson,  Nankivell,  and  Lundell  have  found  a  spirochaete. 

Period  of  Incubation. — Period  of  incubation  varies  from  six  to 
twenty-two  days.  This  has  been  determined  by  experiment. 

Mode  of  Transmission. — Mode  of  transmission  is  believed  to  be 
through  the  louse,  and  there  is  experimental  evidence  corroborative 
of  this  belief. 

Immunity.  Since  the  specific  germ  has  not  been  discovered,  serum 
prophylaxis  and  scrum  therapy  have  not  given  satisfactory  results. 

Prophylaxis.  Trench  fever  is  a  serious  condition  among  troops  in 
the  field.  For  instance,  during  a  year  one  division  of  troops  sent  350 
per  month  to  the  field  hospital.  Since  the  opinion  is  held  and 
corroborated  by  experimental  evidence  that  the  louse  is  the  principal 
medium  of  transmission,  prophylactic  measures  should  embrace  a 
constant  war  upon  the  louse.  Contact  with  cases  of  trench  fever 
should  he  avoided  and  until  there  is  more  accurate  knowledge  of  the 
cause  and  modi-  of  t  r;m>mi>sion  careful  concurrent  disinfection  should 
l>e  prat  ti-ed.  Terminal  fumigation  against  lire  i>  rei ommended. 


422  NAVAL   HYGIENE 

ACUTE  INFECTIOUS  JAUNDICE  OR  WEIL'S   DISEASE 

An  acute  febrile  jaundice  having  remittent  fever  and  muscular  pains  with 
much  prostration  has  been  met  especially  in  the  trenches.  Workers  in 
sewers,  ditches  and  foul  water  are  especially  predisposed  to  this  disease. 
Its  specific  cause  is  the  Spirochate  icterohemorrhagica.  This  disease  is  fre- 
quently met  in  Japan  and  other  countries  where  the  population  work  in  rice 
paddy  fields. 

It  is  not  clear  how  the  organism  gains  entrance  to  the  body,  whether 
through  the  alimentary  canal,  through  open  lesions  of  the  skin,  or  through 
bites  of  some  blood-sucking  form  of  animal  life. 

Prophylaxis. — Inada  claims  that  a  blood  serum  of  convalescents  or  serum 
from  an  immune  horse  is  of  therapeutic  value.  No  immune  serum  appears 
of  prophylactic  value.  Consequently  prophylaxis  consists  in  endeavoring 
to  avoid  infection  through  the  three  routes  above  mentioned. 

RELAPSING  FEVER 

Relapsing  fever  is  an  acute  infectious  disease  due  to  the  spirillum  of 
Obermeier.  This  organism  gains  entrance  to  the  blood  and  after  an  incuba- 
tion period  of  from  four  to  ten  days  produces  the  relapsing  fever  from 
which  it  has  taken  its  name. 

The  disease  is  transmitted  by  body  lice  (Mackie).  Bed  bugs  are  said 
to  transmit  it  (Tiotin).  The  organism  causes  febrile  periods  lasting  about 
six  days,  which  follow  one  another  until  the  infection  dies  out. 

Prophylaxis. — The  prophylactic  measures  directed  against  body  lice  and 
bed  bugs  are  indicated.  Avoidance  of  exposure  and  isolation  of  patients 
should  be  practised  as  in  the  case  of  typhus  fever.  Doctors  and  nurses  should 
be  especially  careful  to  wear  insect-proof  clothing  while  about  the  patient. 

MALTA  FEVER 

Malta  fever  is  an  acute  exhausting  specific  infectious  disease  caused  by 
Micrococcus  melitensis.  The  organism  causes  the  disease  in  goats  and  is  trans- 
mitted to  men  through  the  drinking  of  goat's  milk. 

Prophylaxis. — This  condition  may  be  prevented  by  boiling  the  milk  of 
goats  if  such  milk  is  used  for  human  consumption.  The  habit  of  drinking 
milk  freely  is  very  common  among  the  American  people  and  the  possibility 
of  this  infection  should  be  borne  in  mind  by  medical  officers  who  are  serving 
on  vessels  in  Southern  Europe. 

TYPHUS  FEVER 

Typhus  fever  is  an  acute  infectious  disease  transmitted  by  the  body  louse 
(Nicolle).  It  is  believed  to  be  caused  by  B.  typhi  exanthematici,  a  Gram- 
positive  organism  discovered  by  Plotz.  Ricketts  showed  typhus  to  be  iden- 
tical with  the  Mexican  tabardillo. 

Prophylaxis. — Kill  body  lice  and  their  eggs. 


DISINFECTION 


Disinfection   is   the   process   of   destruction   of   disease-producing 
organisms. 
It  is  either: 

(a)  Concurrent;  or 

(b)  Terminal. 

(a)  Concurrent  disinfection  consists  in  the  destruction  of  patho- 
genic organisms  during  the  course  of  the  illness  wherever  these  organ- 
isms may  be,  whether  in  the  patient's  secretions,  excretions,  skin, 
or  articles  soiled  by  them — including  bath  water. 

(b)  Terminal  disinfection  consists  in  the  disinfection,  after  the  ill- 
ness, of  the  room,  bedding,  and  articles  which  may  have  been  infected 
by  the  patient  during  the  illness.     This  frequently  includes  the  use  of  a 
gaseous  disinfectant  and  the  thorough  washing  of  all  surfaces  with  an 
antiseptic.     Appropriate  disinfection  of  the  patient's  person  should 
not  be  forgotten. 

Disinfectants  may  be: 

A.  Physical; 

B.  Chemical. 

Physical  disinfectants  are : 

1.  Boiling; 

2.  Steam,  under  pressure; 

3.  Streaming  steam; 

4.  Flaming; 

5.  Dry  heat; 

6.  Burning; 

7.  Sunlight. 

B.  Chemical  disinfectants  consist  of: 

1.  Liquids   or   substances    in    solutions    which   act   as   poisons 
destroying  bacteria; 

2.  Gaseous  agents  which  act  similarly. 

423 


424  NAVAL   HYGIENE 

A.  Physical  Disinfectants/ — i.  Boiling  for  a  period  of  one  hour 
will  thoroughly  disinfect  all  articles  to  which  the  method  is  applicable. 
Anthrax  and  tetanus  spores  may  resist  boiling  for  an  hour,  but  the 
vegetative  forms  of  these  organisms  will  be  killed.  Most  pathogenic 
organisms  will  be  killed  by  boiling  thirty  minutes.  Obviously  this 
method  has  its  limitations  in  that  many  articles  would  be  ruined  in 
boiling.  For  the  disinfection  of  a  stool  the  addition  to  it  of  a  gallon  or 
more  of  boiling  water  putting  the  top  on  the  chamber  and  allowing  it 
to  cool  has  proved  satisfactory. 

2.  Steam  under  Pressure. — For  disinfection  of  fabrics,  bedding, 
etc.,  the  application  of  steam  in  the  autoclave  is  most  effective.     Arti- 
cles exposed  to  a  steam  pressure  of  15  pounds  are  under  a  temperature 
of  about  25o°F.     Twenty  minutes  is  sufficient  to  complete  sterilization 
under  these  conditions. 

The  autoclave  is  a  double-jacketed  metal  chamber  which  may  be 
made  air  tight.  The  gaseous  content,  chamber  and  jacket  of  which 
may  be  controlled  independently  by  appropriate  valves  for  supplying 
steam  and  cutting  it  off.  By  another  valve  the  jacket  and  chamber 
are  made  to  communicate.  Necessary  pressure  gauge,  safety  valve, 
and  funnel  for  pouring  water  into  the  jacket  are  provided.  Articles 
to  be  disinfected  are  placed  in  the  chamber  which  is  tightly  closed  and 
steam  is  turned  on  the  chamber  until  the  air  is  expelled.  The  air  cock  is 
then  closed  and  the  pressure  is  allowed  to  increase  to  the  desired  height; 
after  it  is  maintained  sufficiently  long  the  steam  is  shut  off  and  in  some 
cases  a  partial  vacuum  is  established,  thus  facilitating  the  penetration 
of  steam  throughout  the  fabrics  in  the  disinfecting  chamber. 

3.  Streaming  Steam. — Exposure  to  streaming  steam  is  a  satis- 
factory disinfectant  where  applicable.     It  is   similar  in  action  and 
value  to  boiling. 

4.  Flaming. — For  the  disinfection  of  metal  articles  naming  is  very 
satisfactory  and  the  medical  officer  on  board  ship  will  find  that  the 
gasolene  torch  which  is  found  in  the  paint  shop  often  will  be  of  service 
to  him  in  his  efforts  to  prevent  spread  of  communicable  disease. 

5.  Dry  Heat. — Dry  heat  at  a  temperature  of  i5o°C.  will  kill  all 
forms  of  life   if   maintained  for   one  hour.     Rosenau   states   "most 
materials  will  bear  a  temperature  of  no°C.  without  much  injury, 
but  when  this  temperature  is  exceeded  signs  of  damage  soon  begin  to 
show.     Scorching  occurs  sooner  with  woolen  materials  such  as  flannels 
and  blankets  than  with  cotton  and  linen."     He  suggests  using   the 


DISINFECTION  425 

oven  found  in  any  kitchen  when  small  objects  are  to  be  disinfected  by 
d-y  heat  and  recommends  that  the  oven  be  heated  "to  a  point  necessary 
to  brown  cotton,  and  expose  the  objects  no  less  than  one  hour." 

6.  Burning. — Infected  articles  which  are  useless  may  be  destroyed 
by  burning.     There  is  no  better  method  of  disposal  of  sputum,  dress- 
irgs,  and  the  like. 

7.  Sunlight. — Microorganisms  exposed  to  sunlight  are  killed  in  a 
comparatively  brief  time  by  dessication  and  by  the  direct  action  of 
the  sun's  rays  upon  the  protoplasm  of  the  organism. 

B.  Chemical  Disinfectants. — Liquids  or  substances  in  solution. 

(a)  Bichloride  of  mercury; 

(b)  Carbolic  acid; 

(c)  Formalin. 

(a)  Bichloride  of  mercury  (HgCy  or  "corrosive  sublimate"  is 
one  of  the  most  common  disinfectants  in  use  and  kills  all  forms  of 
animal  life  in  solution  in  strength  of  i  to  1000.  For  killing  spores 
a  solution  of  i  to  500  should  be  used. 

Bichloride  of  mercury  is  a  heavy,  white  crystalline  substance  which 
is  highly  poisonous  to  man.  Bichloride  dissolves  slowly  in  water. 
The  addition  to  the  water  of  ammonium  chloride,  table  salt  (NaCl), 
or  hydrochloric  acid  (HC1),  aids  in  solution. 

For  disinfection  of  ships  with  bichloride  of  mercury,  sea  water  is 
useful,  since  it  contains  nearly  3  per  cent,  of  sodium  chloride  and  a 
small  amount  of  ammonium  chloride.  Geddings  recommends  weighing 
the  necessary  amount  of  bichloride,  placing  it  in  a  bag,  and  attaching 
to  it  a  faucet,  the  bichloride  being  dissolved  by  the  water  while  it  is 
pacing  through  the  bag.  The  solution  of  bichloride  of  mercury  always 
should  be  tinted  with  some  coloring  matter  in  order  to  prevent  mis- 
taking it  for  water.  It  may  be  applied  with  a  hose  for  washing  down 
decks  and  bulkheads  of  compartments  requiring  disinfection,  or  the 
surfaces  may  be  scrubbed  down  with  rags  or  brushes. 

Rosenau  calls  attention  to  the  volatility  of  bichloride  of  mercury 
and  recommends  rinsing  surfaces  upon  which  it  has  been  used  on  a 
large  scale  with  fresh  water  in  order  to  avoid  bichloride  poisoning. 
Solutions  of  bichloride  of  mercury  are  unsuitable  for  the  destruction 
oi  •  •rganisnis  in  feCefl  and  sputum.  They  precipitate  albumin,  thus 
throwing  an  envelope  around,  without  penetrating  to  the  center  of 
masses  containing  living  bacilli. 


426  NAVAL  HYGIENE      . 

Infected  linen  may  be  soaked  in  solution  of  bichloride  and  subse- 
quently rinsed  in  fresh  water.  Bichloride  does  not  injure  fabrics 
but  corrodes  metal,  consequently  should  not  be  used  in  disinfecting 
water  closets  or  plumbing. 

Bichloride  is  not  a  deodorant. 

(b)  Carbolic  acid  is  one  of  the  most  popular  disinfectants  and  is 
especially  useful  for  disinfecting  excreta,  sputum,  and  also  wood  and 
metal  and  linen.     It  is  a  coal-tar  product  which  is  used  in  solution 
from  2^/2  to  5  per  cent.     Unlike  bichloride  of  mercury  solution,  it 
causes  local  symptoms  promptly  when  it  comes  in  contact  with  the 
skin.     The  spot  turns  white,  tingles,  becomes  anaesthetic  and  in  some 
cases  gangrenous.     Prompt  application  of  alcohol  is  the  best  antidote 
for  its  local  effect.     Carbolic  acid  is  a  mixture  of  phenols  and  creso)s 
and  depends  upon  these  for  its  disinfectant  qualities.     Phenol  has  the 
same  disinfecting  properties  as  carbolic  acid  since  it  is  the  principal 
component  of  the  latter,  and  its  range  of  applicability  corresponds  to 
that  of  carbolic  acid.     Various  other  coal-tar   products  are  sold  as 
disinfectants  and  their  effects  are  much  the  same  as  those  of  carbolic 
acid.     Creolin,    lysol,    sanitol,    naphthol*,    aseptol,    solveol,    asaprol, 
cresol,  naphthalene  and  other  coal-tar  derivatives  are  also  used.     Car- 
bolic acid  and  phenol  are  the  best  and  in  solution  of  3  to  5  per  cent, 
will  kill  all  non-spore-bearing  bacteria  in  from  one-half  to  an  hour. 

(c)  Formalin. — Formalin,  a  40  per  cent,  solution  of  formaldehyde 
in  water,  is  an  excellent  disinfectant  for  sputum,  urine,  feces  or  linen 
soiled  by  them. 

The  formalin  should  be  of  standard  strength  and  should  be  used  in 
strength  of  10  per  cent,  of  formalin  in  water. 

GASEOUS  DISINFECTANTS 


Two  gaseous  disinfectants  are  recommended  for  use  on  board  ship. 
These  are  formaldehyde  and  sulphur  dioxide.  Formaldehyde  is  the 
best  germicide,  sulphur  dioxide  the  best  f umigant  for  the  extermination 
of  vermin. 

Hydrocyanic  acid,  carbon  monoxide,  carbon  disulphide,  and  chlorine 
all  have  a  limited  range  of  action  and  are  not  considered  desirable. 

Hydrocyanic  acid  is  extremely  poisonous,  and  being  without  odor 
or  color  has  repeatedly  resulted  in  death  to  those  who  have  unwittingly 
entered  compartments  containing  the  gas  in  lethal  concentration.  It 


42' 

is  a  valuable  fumigant  against  vermin  and  less  so  against  bacteria, 
bul  is  so  dangerous  that  it  should  not  be  employed  by  any  who  are  not 
thoroughly  skilled  in  using  it.  Fatal  accidents  have  happened  as  result 
of  the  pocketing  of  this  gas  in  the  holds  of  ships  that  had  been  disin- 
fected by  it,  the  holds  having  been  opened  and  supposed  to  be 
thoroughly  aerated  and  freed  from  the  disinfectant. 

Carbon  monoxide  and  the  gases  of  combustion  in  ships'  furnaces 
have  been  ingeniously  applied  to  disinfection  of  holds  of  cargo-carrying 
ships.  This  method  has  proved  satisfactory  but  requires  elaborate 
and  expensive  apparatus.  This  gas  being  odorless,  tasteless,  and  very 
toxic  can  be  used  only  in  holds  of  ships  which  are  unoccupied. 

Carbon  disulphide  is  occasionally  used  against  vermin,  is  highly 
poisonous,  but  its  disagreeable  odor  is  a  safeguard.  Its  explosive 
quality  renders  it  unsafe  for  use. 

Chlorine  is  highly  toxic  for  animal  and  vegetable  life  and  damages 
fabrics,  colors,  and  metal  to  such  extent  that  it  should  not  be  employed 
when  other  fumigants  are  available. 

Preparation  of  the  Space  to  be  Disinfected.— The  disinfection  of  a 
room  requires  careful  attention  to  detail  on  the  part  of  those  doing  the 
work.  The  room  should  be  as  nearly  hermetically  sealed  as  possible. 
The  cracks  around  the  doors,  transoms,  windows,  fire-places,  entrances 
of  radiator  pipes,  heating  and  ventilating  openings  should  be  made  air- 
tight by  pasting  paper  over  them.  For  the  closure  of  cracks  in  the 
doors,  windows  and  the  like,  the  writer  has  found  the  following  to  be  a 
useful  method:  Cut  strips  of  newspaper  sufficiently  wide,  say  3 
inches,  smear  green  soap  over  them  and  then  paste  over  the  cracks. 
This  will  l>e  found  to  be  air-tight  and  has  the  advantage  of  dissolving 
readily  with  water  when  it  is  desired  to  remove  the  paper  after  disinfec- 
tion. Starch  paste,  Hour  paste,  and  the  like  may  be  used,  but  green 
soap  is  preferable  when  available.  The  key  hole,  voice  tubes,  and  the 
•crark  at  the  meeting  rail  of  upper  and  lower  windowsashes.should  not  be 
forgotten.  Material  and  utensils  should  he  in  readi ness  to  seal  the  door 
of  exit  after  the  operator  has  started  the  generation  of  the  disinfectant, 
and  hurriedly  has  left  the  room. 

On  board  ship  the  fumigation  of  certain  compartments  is  compara- 
tively easy,  and  in  other  cases  extremely  dimrult.  The  presence  of 
water-ti«;ht  doors  and  air-ports,  each  of  which  has  its  rubber  gasket, 
enables  the  closure  of  these  openings  without  pasting  paper  over  them. 
The  ventilating  louvers  must  be  tightly  closed  by  sealing  them  up, 


428  NAVAL   HYGIENE 

and  care  must  be  taken  to  see  that  the  small  triangular  openings  which 
result  from  the  overlapping  of  steel  plates  at  their  point  of  contact 
with  a  bulkhead  are  also  closed.  In  state  rooms  the  grating  at  the  top 
for  purposes  of  ventilation  should  be  closed.  Any  metal  in  the  room, 
especially  brass,  should  be  coated  with  vaseline  if  sulphur  dioxide  is  to 
be  used.  Drawers  should  be  opened  and  their  contents  shaken  out  or 
strung  on  lines  in  the  room.  Bedding  should  be  similarly  treated,  to 
enable  the  gas  to  come  in  contact  with  all  surfaces  and  be  disinfected, 
since  the  gaseous  disinfectants  possess  little  or  no  penetrating  power. 

In  large  compartments  on  the  gun  deck  there  may  be  great  difficulty 
in  closing  sufficiently  to  perform  a  fumigation.  In  such  case  thorough 
aeration  and  the  use  of  disinfectant  solutions  will  accomplish  the  desired 
effect.  If  the  fumigation  of  a  ship  is  intended  to  be  general,  preparation 
should  be  made  to  commence  the  generation  of  the  fumigant  almost 
synchronously  in  the  various  parts  of  the  ship.  It  is  desirable  to  com- 
mence at  one  end  of  the  ship,  disinfecting  one  compartment  after 
another  and  driving  rodents  and  vermin  ahead  of  the  disinfecting  proc- 
ess toward  the  other  end  of  the  ship.  Employment  of  this  method  is 
more  apt  to  result  in  extermination  of  vermin  than  if  isolated  compart- 
ments are  fumigated  from  time  to  time,  the  vermin  being  driven 
from  a  compartment,  seeking  refuge  in  an  adjacent  one  and  returning 
to  infest  the  fumigated  one  after  the  process  is  repeated. 

Formaldehyde. — Formaldehyde  is  a  most  useful  disinfectant,  but 
is  not  an  insecticide.  German  cockroaches  thrive  upon  it.  It  is 
non-poisonous,  does  not  corrode  metal,  does  not  injure  fabric  or  fade 
colors,  and  declares  its  presence  by  its  odor  and  irritating  qualities 
to  the  mucous  membranes.  It  polymerizes  at  low  temperatures  and 
disinfection  with  it  is  unreliable  if  the  temperature  of  the  space  to  be 
disinfected  is  below  65 °F.  A  certain  amount  of  moisture  in  the  atmos- 
phere is  necessary  to  its  successful  action,  and  if  the  relative  humidity 
is  below  60  per  cent,  moisture  should  be  added  to  the  air  of  the  room. 
It  diffuses  with  about  the  same  rapidity  as  atmospheric  air.  In  the 
generation  of  this  gas  for  each  1000  cubic  feet  of  space  to  be  disinfected 
a  separate  generating  apparatus  should  be  employed,  and  the  generators 
should  be  distributed  throughout  the  space  preferably  4  feet  above  the 
floor  in  order  to  insure  uniform  generation  of  the  gas.  As  considerable 
heat  is  generated  during  the  evolution  of  the  gas  the  containers  should 
not  be  set  upon  surfaces  which  would  be  injured  by  heat — for  instance 
carpets  and  varnished  wood. 


DISINFECTION  429 

There  are  several  methods  of  generating  formaldehyde.  The 
following  i^  In 

ttarium  Dioxide  Method. — One-half  pound  of  barium  dioxide 
(technical  containing  not  less  than  78  per  cent,  of  BaO2)  crystals  should 
be  evenly  distributed  on  the  bottom  of  the  bucket  or  other  metal  con- 
tainer. Upon  this  is  poured  i  pint  of  formalin  (solution  of  formalde- 
hyde 40  per  cent.  U.S.P.).  These  proportions  of  the  ingredients  suffice 
for  the  disinfection  of  1000  cubic  feet  of  space.  The  metal  container 
should  have  pressed  seams  as  the  heat  generated  would  melt  solder. 
The  formalin  should  be  poured  into  a  pitcher  so  that  it  may  be  quickly 
poured  into  the  bucket.  This  precaution  is  necessary  as  the  gas  is 
immediately  and  rapidly  evolved  when  the  chemicals  come  together. 
The  method  is  a  cheap,  safe,  and  efficient  process  for  rapid  evolution 
of  formaldehyde  and  possesses  the  advantage  of  supplying  the  necessary 
moisture. 

The  container  may  be  readily  cleaned  since  no  discoloration  is 
produced  as  in  the  permanganate  method. 

The  Health  Department  of  the  State  of  Pennsylvania  uses  the 
following  method: 

Sodium  dichromate 10  ounces 

Formalin 16  ounces 

Commercial  sulphuric  acid ij£  ounces. 

The  last  two  ingredients  may  be  mixed  and  kept  in  stock,  the  mix- 
ture being  poured  upon  the  sodium  dichromate  when  it  is  desired  to 
employ  this  method.  The  gas  is  b'berated  rapidly. 

The  Potassium  Permanganate  Method. — This  method  formerly 
much  used  is  convenient,  wasteful,  and  dirty.  For  each  1000  cubic 
feet  of  space  to  be  disinfected  500  c.c.  of  formalin  are  poured  upon 
250  grams  of  potassium  permanganate.  As  in  the  barium  dioxide 
method  there  is  much  spattering,  heat  is  rapidly  generated,  and  the 
floor  or  surface  upon  which  the  container  rests  should  be  protected 
by  placing  a  brick  or  something  of  the  kind  under  it.  The  process 
occurs  with  almost  explosive  violence  and  permanganate  stain  may  be 
spattered  some  distance  about  the  container.  Owing  to  the  present 
high  price  of  potassium  permanganate  this  method  is  expensive. 

The  three  methods  above  described  enable  the  rapid  evolution  of 
laru'c  (|iiantities  of  gas. 

Walker  describes  the  following  useful  method  for  each  1000  cubic 
feet: 


430  NAVAL   HYGIENE 

Sol.  A — Aluminium  sulphate 150  grams 

Dissolved  in  hot  water 300  c.c. 

Sol.  B — Formalin  (40  per  cent.  CHOH). . .  .  600  c.c. 

Lime — Unslaked  lime 2000  grams. 

Mix  solutions  A  and  B  and  pour  upon  the  lime. 

Solution  A  and  B  are  mixed,  poured  upon  the  lime,  the  slaking  of 
which  generates  heat;  the  formaldehyde  is  driven  off. 

The  various  lamps  and  retorts  for  generation  of  formaldehyde  are 
unreliable. 

Apparatus  has  been  devised  by  which  formaldehyde  is  admitted 
into  an  autoclave  in  which  a  vacuum  has  been  produced  by  steam  under 
pressure.  Since  the  steam  under  pressure  will  certainly  sterilize 
and  will  penetrate,  formaldehyde  is  unnecessary,  except  for  articles 
which  would  be  injured  by  steam. 

On  board  ship  in  small  state  rooms  and  in  small  inclosures  such  as 
closets  and  bureau  drawers,  the  method  of  sprinkling  formalin  may 
be  satisfactorily  employed. 

For  the  disinfection  of  small  rooms  Rosenau  recommends  the 
suspension  of  a  bed  sheet  on  a  line  in  the  room  and  sprinkling  it  with 
formalin.  He  states  that  "a  surface  of  about  2  by  2^  yards  is  required 
for  every  1000  cubic  feet  of  space  of  the  room.  Properly  sprinkled 
this  will  carry  without  dripping  8  ounces  of  formalin." 

A  room  disinfected  by  formaldehyde  should  remain  closed  for 
twenty-four  hours  in  order  to  obtain  full  effect  of  the  gas  upon  all 
exposed  surfaces. 

Sulphur  Dioxide. — Sulphur  dioxide  is  par  excellence  the  best  fumi- 
gant  for  use  against  vermin.  For  its  germicidal  effect  the  addition 
of  moisture  to  the  atmosphere  is  required,  the  moisture  in  the  air  plus 
the  sulphur  dioxide  results  in  the  formation  of  sulphurous  acid  which  is 
germicidal. 

In  concentration  sulphur  dioxide  produces  corrosive  effect  upon 
exposed  metal  and  attacks  fabrics.  The  action  upon  fabric  is  not  im- 
mediate but  manifests  itself  slowly,  perhaps  after  laundering.  For 
germicidal  action  a  concentration  of  5  per  cent,  of  the  gas  should  be 
employed — 3  per  cent,  is  sufficient  for  use  against  vermin.  Of  the 
several  methods  of  application  the  most  practical  is  the  burning  of 
pulverized  roll  sulphur  or  of  flowers  of  sulphur. 

For  germicidal  effect  5  pounds  of  sulphur^should  be  burned  per 


DISINFECTION  431 

cubic  feet  of  space  to  be  disinfected,  and  moisture  should  be 
added  to  the  air  in  proportion  of  i  pint  per  1000  cubic  feet. 

For  Vermin. — Two  to  four  pounds  of  sulphur  per  1000  cubic  feet 
should  be  burned  for  fumigation  against  vermin.  For  this  purpose 
the  addition  of  water  is  unnecessary  and  its  omission  results  in  less 
damage  to  fabric  or  metal. 

The  following  important  points  should  be  observed  in  sulphur 
fumigation: 

1.  The  room  should  be  tightly  sealed; 

2.  The  sulphur  should  be  placed  in  a  shallow  iron  pot  or  vessel 
of  solid  casting; 

3.  This  vessel  should  be  set  in  a  somewhat  larger  one  partially 
filled  with  water  if  germicidal  action  is  desired. 

When  the  sulphur  burns  sufficient  amount  of  water  is  vaporized 
to  make  the  sulphur  dioxide  effective  against  microorganisms.  The 
water  also  is  a  safeguard  against  fire.  The  writer  has  found  that  the 
ignition  of  sulphur  is  difficult  even  with  the  addition  of  a  small  amount 
of  alcohol,  and  has  found  the  following  the  most  satisfactory  way  of 
preparing  the  pot  for  ignition.  The  necessary  amount  of  sulphur 
for  each  pot  is  weighed.  The  interior  of  the  pot  is  thoroughly  dried. 
A  newspaper  is  lightly  crumpled  and  put  in  the  bottom  of  the  pot.  The 
powdered  sulphur  is  then  poured  over  the  newspaper.  To  this  is 
added  sufficient  alcohol  and  the  pot  is  ready  for  ignition.  Vessels 
with  soldered  seams  or  which  have  been  patched  by  soldering  should 
not  be  used  as  sulphur  pots,  for  the  heat  generated  melts  the  solder  and 
the  water  in  which  the  pot  is  resting  flows  in  and  extinguishes  the  flame. 
If  apparatus  is  available  not  in  excess  of  10  pounds  of  sulphur  per  pot 
should  be  used.  It  is  much  better  to  use  a  larger  number  of  pots  as 
the  gas  is  better  distributed  throughout  the  compartments  and  the 
complete  combustion  is  more  nearly  probable. 

Sulphur  dioxide  is  heavier  than  air,  sinks  to  the  bottom  of  the  com- 
partment and  tends  to  extinguish  the  burning  pots  by  cutting  off  their 
oxygen  supply.  Consequently  the  pots  should  be  placed  as  far  above 
the  floor  as  it  is  practicable,  upon  boxes  of  scaffolding  temporarily 
erected  for  the  purpose.  When  all  is  ready  the  pots  farthest  from  the 
exit  should  be  ignited,  and  the  others  ignited  as  the  operator  goes  toward 
the  door.  Having  satisfied  himself  all  are  burning  the  door  should  be 
closed  and  sealed.  If  disinfecting  against  microorganisms  the  room 
should  be  kept  sealed  for  twenty-four  hours.  Three  hours  is  sufficient 


432  NAVAL   HYGIENE 

when  fumigating  against  vermin,  but  the  space  should  be  left  closed 
for  twelve  hours  if  practicable. 


QUARANTINE 

Medical  officers  of  ships  acting  as  health  officers  of  the  population 
under  their  charge  are  required  to  comply  with  the  quarantine  laws 
of  this  and  other  countries,  and  also  naval  medical  officers  from  time 
to  time  are  required  to  act  as  health  officers  of  the  port  in  certain  of 
our  colonial  possessions. 

Ships  arriving  in  the  United  States  with  any  one  of  the  following 
diseases  on  board  are  quarantinable;  namely:  leprosy,  cholera, 
plague,  smallpox,  yellow  fever  and  typhus  fever. 

Alien  lepers  are  not  permitted  to  land.  Lepers,  if  citizens  of  the 
United  States,  must  be  handled  in  accordance  with  the  local  laws  in 
force  at  the  port  of  landing. 

Persons  exposed  to  cholera  should  be  quarantined  for  the  full  period 
of  incubation;  namely,  five  days;  yellow  fever,  six  days;  smallpox, 
eighteen  days;  typhus  fever,  twelve  days;  plague,  seven  days. 

The  certificate  of  a  naval  medical  officer  concerning  the  sanitary 
conditions  prevalent  on  his  ship  is  usually  accepted  by  the  health 
authorities  of  the  port. 

When  the  naval  medical  officer  is  acting  as  health  officer  of  a  port 
he  should  upon  boarding  an  incoming  vessel  make  a  quick  survey  of 
general  appearance  of  passengers  on  deck.  He  should  then  call  for  the 
medical  officer  of  the  ship.  If  a  naval  vessel  the  certificate  of  the 
medical  officer  should  be  accepted,  provided  his  bill  of  health  is 
satisfactory.  If  a  merchant  vessel  is  boarded  the  ship's  physician 
should  be  required  to  show  his  bill  of  health,  interrogated  as  to  develop- 
ment of  any  infectious  disease  during  passage,  journal  and  clinical 
records  should  be  read,  and  sick  should  be  examined.  If  any  have  died 
at  sea  the  bodies  should  be  viewed  and  autopsied  if  necessary.  Then 
a  general  muster  of  all  hands  should  take  place,  and  a  careful  count  of 
passengers  and  crew  should  be  made  and  the  result  compared  with  the 
number  of  souls  on  board  ship  as  given  in  the  bill  of  health.  Any  dis- 
crepancy found  should  be  brought  to  the  attention  of  the  commanding 
officer  for  explanation.  The  general  muster  should  include  a  careful 
examination  of  all  hands,  for  unscrupulous  captains  have  compelled  men 
sick  with  quarantinable  disease  to  stand  in  line  to  try  to  pass  quarantine 


DISINFECTION 


433 


muster.  After  the  muster  a  general  view  of  the  vessel  should  be  taken 
a  id  rargo  containing  f<><>d  stuffs,  grain,  cereals,  and  Hour  should  be 
examined  carefully  as  they  are  apt  to  harbor  vermin.  The  attitude 
o  the  captain  of  the  vessel  and  of  the  ship's  surgeon  should  be  carefully 
considered  in  all  cases.  Treatment  of  those  sick  of  quarantinable 
disease  and  management  of  quarantine  station  cannot  be  discussed  here. 


CHAPTER  XXXVI 
DISPOSAL  OF  THE  DEAD 

For  sentimental  reasons  so  well-grounded  in  the  popular  mind  that 
they  cannot  be  ignored,  and  because  of  effect  on  morale  of  the  sailor- 
man,  effort  is  made  to  return  to  their  homes  the  bodies  of  those  in  the 
naval  service  who  die  at  sea  or  abroad.  If  the  death  results  from  an 
infectious  disease  the  body  must  be  interred  abroad  for  the  period  of 
one  year  before  it  may  be  returned  to  the  United  States. 

The  bodies  of  those  who  die  on  board  ship  should  be  embalmed 
for  preservation  and  shipment. 

Embalming. — Complete  saturation  of  the  body  tissues  with  the 
embalming  fluid  must  be  accomplished. 

Both  brachial,  both  femoral  and  both  common  carotid  arteries 
should  be  injected.  The  arteries  of  the  extremities  should  be  injected 
peripherally. 

One  carotid  should  be  injected  toward  the  head  and  the  other  toward 
the  heart. 

Francis  says  an  amount  of  fluid  equal  in  weight  to  15  per  cent,  of 
body  weight  should  be  injected  if  the  body  is  to  be  kept  long  in  warm 
temperatures.  Of  this  each  brachial  should  receive  i  per  cent,  of  the 
body  weight;  each  femoral  2  per  cent.;  the  common  carotid  injected 
toward  the  head  2  per  cent.,  and  that  toward  the  heart  2  per  cent. 

Body  cavities  should  be  injected,  and  if  autopsied  special  care  must 
be  taken  to  see  that  the  vessels  are  well  filled  and  tied. 

A  bicycle  pump  and  a  3-gallon  bottle  having  a  rubber  stopper 
perforated  by  two  glass  tubes,  one  of  which  extends  to  the  bottom  of 
the  bottle,  and  is  connected  with  the  rubber  tube  which  terminates 
in  the  injecting  needle,  the  other  tube  which  pierces  the  stopper  is 
connected  with  the  bicycle  pump  and  extends  into  the  bottle  only 
sufficiently  far  to  discharge  air  above  the  level  of  the  fluid,  constitute 
the  injecting  apparatus. 

The  ordinary  fountain  syringe  or  irrigating  bottle  equipped  with 
a  cannula  or  needle  may  be  used.  The  aspirator  which  is  supplied  in 

434 


DISPOSAL   OF   THE   DEAD 


435 


the  medical  department  when  appropriately  connected  is  an  excellent 
instrument  for  injection  and  also  for  aspiration  of  blood  if  necessary. 
The  following  solution  has  been  found  most  satisfactory  by  the 
Hygienic  Laboratory  of  the  U.  S.  Public  Health  Service: 

Liquor  formaldehyde 

(U.S.P.  solution  of  formaldehyde) 13.5  c.c. 

Sodium  borate  (Na2B4O7,  borax) 5    grams. 

Water  sufficient  to  make 100    c.c. 


z. — An  embalming  apparatus  easily  improvised.     It  consists  of  a  bicycle 
pump,  a  jar,  a  cannula,  and  some  tubing. 

It  is  stable. 

Bodies  injected  with  this  fluid  have  been  well  preserved  after 
exposure  to  a  temperature  of  98°?.  for  two  months. 

Massage  will  remove  postmortem  staining  of  the  face.  Before  they 
can  be  moved  bodies  dead  of  infectious  disease  must  be  washed  in  an 
approved  disinfectant  fluid  after  embalming. 

All  body  orifices  should  be  plugged  with  absorbent  cotton  saturated 
with  the  fluid.  The  body  should  be  covered  with  a  cotton  layer  i 
inch  thick  and  wrapped  in  a  sheet  wet  with  disinfectant. 


436  NAVAL   HYGIENE  , 

For  shipment  of  over  twenty-four  hours  the  body  must  be  prepared 
as  above  described  and  encased  in  a  hermetically  sealed  (soldered)  tin 
case  inside  the  coffin. 

Burial  at  Sea. — When  it  is  impracticable  to  return  a  body  to  its 
home  it  may  be  necessary  to  bury  it  at  sea,  in  which  case  it  is  sewed  in 
tarpaulin,  weighted,  and  slid  overboard  with  appropriate  ceremony. 

In  Action. — During  or  after  an  action  in  which  many  persons  are 
killed  it  may  be  necessary  to  throw  the  dead  overboard  as  rapidly  as 
possible  for  the  two-fold  purpose  of  clearing  the  ship  of  the  bodies 
and  for  effect  upon  the  morale  of  the  crew.  In  such  circumstances 
the  conditions  may  be  so  urgent  as  to  warrant  committing  the  bodies 
to  the  sea  without  sewing  in  tarpaulin — time  and  material  not  being 
available. 

Disposal  of  the  Dead  on  Shore. — When  naval  forces  are  operating 
on  shore  and  numbers  of  men  are  killed  they  must  be  buried  on  the 
field. 

The  site  should  be  chosen  with  view  to  minimize  effort  during  trans- 
portation, due  care  being  taken  to  avoid  proximity  to  dwellings,  water 
supplies,  or  places  likely  to  be  flooded.  A  dry  sandy  soil  with  gentle 
slope  is  best  if  available.  Large  graves,  holding  say  100  bodies, 
may  be  used.  Clothing  should  be  removed  from  the  bodies  and  no 
antiseptics  should  be  employed.  The  trenches  should  contain  a  single 
row  of  bodies  and  should  have  at  the  bottom  of  the  large  trench  a  small 
trench  about  a  foot  deep  lined  with  stones  or  boughs,  or  some  such 
materials,  for  draining  the  larger  trench.  In  filling  the  trench  it  should 
be  remembered  that  access  of  air  and  circulation  of  ground  water  favor 
bacterial  growth  and  produce  rapid  decomposition.  A  vent  made  of 
three  boards  perforated  with  auger  holes  should  extend  to  the  bottom 
of  the  trench  in  order  to  enable  the  escape  of  gases  of  decomposition. 

The  corpses  should  be  covered  with  boughs,  useless  articles  of  cloth- 
ing, then  the  turf,  and  the  grave  filled  in  with  earth.  Appropriate 
markers  should  be  placed  if  the  bodies  can  be  identified. 

When  for  any  reason  putrefying  bodies  are  exposed,  if  they  cannot 
be  buried  immediately  they  should  be  treated  with  a  5  per  cent,  cresol 
solution,  quicklime,  or  a  10  per  cent,  solution  of  ferric  sulphate. 

The  writer  has  seeen  bodies  incinerated  after  battle  by  placing  them 
in  layers  between  which  were  interposed  fire  wood.  The  wood  and  the 
bodies  were  drenched  with  kerosene  and  the  pyre  ignited.  This  method 
is  commended  where  practicable  since  it  prevents  fouling  and  infection 


DISPOSAL    OF   THE   DEAD 


437 


of  ground  water.     The  ashes  can  be  buried  and  appropriate  markers 
may  be  established. 

It  is  alleged  that  the  German  Government  has  disposed  of  some  of 
the  dead  by  rendering  the  bodies,  obtaining  a  lubricating  oil  from  the 
fats  and  a  compressed  material  which  is  used  as  food  for  hogs. 


CHAPTER  XXXVII 
VITAL  STATISTICS 

Vital  statistics  are  mathematical  expressions  of  the  extent  and 
movement  of  morbidity  and  mortality  in  a  given  population.  By 
means  of  these  expressions  studies  in  prophylaxis  and  comparisons  of 
results  of  effort  to  conserve  health  may  be  made. 

Values  of  methods  of  treatment  may  be  tested  and  the  results 
expressed  in  terms  capable  of  comparison.  Disease  and  injury  in 
sex,  age,  and  occupational  groups  gain  expression  in  terms  of  comparison 
comprehensible  by  the  layman  who  must  appropriate  funds  for  the 
carrying  forward  of  public  health  work  and  must  legislate  for  the 
maintenance  of  the  health  of  the  people. 

Manifestly  the  value  of  vital  statistics  depends  upon  accuracy 
of  diagnosis  and  scrupulous  care  in  the  keeping  of  the  records.  The 
statistics  which  are  being  compiled  by  the  military  arms  of  the  federal 
service  are  probably  as  accurate,  if  not  the  most  accurate  of  any,  for 
the  same  population,  and  medical  officers  cannot  be  too  careful  in 
endeavoring  to  eliminate  error  of  any  kind  from  their  reports. 

The  naval  medical  officer  should  understand  the  meaning  of  several 
terms  commonly  used  in  connection  with  the  vital  statistics  of  the 
Navy.  These  are: 

1.  The  average  strength; 

2.  The  sick  day; 

3.  The  daily  average  of  sick; 

4.  The  percentage  of  sick; 

5.  The  ratio  per  thousand  of  admission,  invaliding  and  death. 

i.  The  Average  Strength. — By  the  average  strength  is  meant  the 
daily  average  population  during  the  period  of  time  under  consideration. 
If  the  daily  average  number  of  persons  on  board  a  ship  during  a  week, 
month,  or  year  is  1125,  this  number  is  the  average  strength  of  the  ship. 
It  includes  officers  and  enlisted  men,  sick  and  well. 

Probably  it  may  be  most  accurately  determined  by  appropriate 

438 


VITAL   STATISTICS  439 

calculations  based  upon  the  amount  of  money  paid  by  a  given  unit 
to  the  naval  hospital  fund  during  a  given  time.  The  law  requires 
that  each  person  in  the  naval  service  contribute  20  cents  a  month  from 
his  pay  to  the  naval  hospital  fund.  If  during  three  months  the  total 
checkages  for  the  hospital  fund  aggregate  $720,  this  amount  will 
represent  20  cents  a  month  checked  three  times  (months)  for  each 
individual  on  board,  consequently  $720  divided  by  60  cents  will  give 
1200,  the  average  strength  of  the  crew  during  the  three  months. 

A  common  method  of  obtaining  the  average  strength  is  to  divide 
the  number  of  rations  issued  during  the  period  of  time  by  the  number 
of  days  in  that  period.  One  ration  per  day  is  allowed  to  each  enlisted 
man.  Hence  the  number  of  rations  issued  during  a  given  period 
divided  by  the  number  of  days  in  that  period  will  give  the  average 
strength.  This  appears  the  simpler,  but  since  rations  are  not  allowed 
to  the  officers  it  is  obvious  that  a  considerable  factor  of  error  occurs  in 
tiis  method. 

2.  The  Sick  Day. — The  "sick  day"  means  one  man  sick  one  day. 

3.  The  Daily  Average  of  Sick. — The  daily  average  of  sick  is  obtained 
v  dividing  the  total  number  of  sick  days  for  a  given  period  by  the 

number  of  days  in  that  period.  For  instance,  if  the  number  of  sick 
days  for  the  third  quarter  of  the  year  amounts  to  644  on  board  the  U. 
S.  S.  North  Dakota  and  the  total  number  of  days  in  that  quarter  is  92, 
then  the  daily  average  number  of  sick  is  obtained  by  dividing  644  by 
92  equals  7,  or  an  average  of  7  persons  sick  each  day  during  the  quarter. 
The  daily  average  of  sick  for  the  year  may  be  obtained  on  the  same 
principle. 

4.  Percentage  of  Sick. — The  percentage  of  sick  may  be  determined 
by  multiplying  the  number  of  sick  days  during  a  given  period  by  100 
and  dividing  the  product  by  the  average  strength  multiplied  by  the 
number  of  clays  in  the  period.     For  instance,  if  on  the  U.  S.  S.  Arkansas 
during  the  first  quarter,   1915  there  were   270  sick  days  because  of 
fractures,  what  was  the  percentage  of  sick  for  this  injury  if  the  average 
s  rength  of  the  crew  was  1200? 

^__^ 270  (sick  days)  X  100 

1200  (average  strength)  X  go  (no.  of  (lays  in  first  quarter  of  1915)" 

=  0.25  or  '  ,   per  cent.  •  the-  percentage  of  the  crew  on  the 
i  200  X  go 

sick  list  each  day  during  the  quarter  because  of  fractures.  This  means 
1200  X  0.0025  =  3  men. 


440  NAVAL   HYGIENE 

5.  The  Rates  per  1000  of  Admissions,  Invalidings  and  Deaths.— 

The  rate  of  admissions,  invalidings,  and  deaths  may  be  expressed  in 
rate  per  1000  of  average  strength.  This  may  be  obtained  by  multiply- 
ing the  total  number  of  admissions,  invalidings  or  deaths  by  1000  and 
dividing  by  the  average  strength. 

For  instance,  there  were  287  admissions  to  the  sick  list  in  the  Navy 
for  tuberculosis  during  the  year  1916.  What  was  the  rate  per  1000 
if  the  average  complement  of  the  Navy  was  69,294? 

287  (total  number  of  admissions)  X  1000 

,,  v  -  =  4.14  per  1000. 

69,294  (average  strength) 

Since  there  are  69  29Mooo  thousands  in  the  average  complement 
the  ratio  per  1000  also  may  be  determined  by  dividing  the  total  number 
of  sick  days  by  the  number  of  thousands. 

287  ^  69  29^ooo  =  4-I4- 

The  average  strength  or  complement  maybe  expressed  in  thousands 
by  pointing  off  three  decimal  places,  e.g.,  69, 294  =  69  29^f  ooo  °r  69.294 
thousands. 

Consequently  the  rate  per  1000  for  admission,  invaliding  from  ser- 
vice, or  for  death  may  be  found  by  dividing  the  total  number  of  sick 
days  by  the  average  strength  in  which  three  decimal  places  have  been 
pointed  off.  Taking  the  above  example  287  -f-  69.294  =  4.14  per  1000. 


CHAPTER  XXXVIII 
JARY  OF  NAUTICAL  TERMS  USED 
A 


Abeam — opposite  the  center  of  the  ship's  side. 

Accomodation  ladder — a  ladder  shipped  at  the  gangway  for  board- 
ing a  vessel  in  port. 

After -part — third  division  or  rear  portion  of  a  ship;  that  portion 
farthest  from  the  bow. 

B 

Beams — horizontal  bars  of  metal  connecting  corresponding  star- 
board and  port  frames,  and  supporting  the  decks. 

Belay — to  secure,  make  fast,  or  stop. 

Bilge — the  flat  part  of  the  ship's  body  on  each  side  of  the  keel. 

Bilge  keel — large  pieces  of  metal  secured  near  the  turn  of  the  bilge 
to  lessen  the  ship's  motion  while  rolling. 

Bill  board — a  ledge  on  the  bow  of  a  ship  to  support  the  anchor  fluke. 

Bitts — vertical  posts  of  metal  or  timber  securely  fastened  in  the 
deck;  hawsers  are  secured  to  them. 

Boatswain — a  warrant  officer  who  has  care  of  the  ground  tackle, 
stores  and  apparatus  on  deck. 

Bollard — a  vertical  pile  to  which  ship's  hawsers  may  be  secured. 

Boom — a  long  spar  extending  from  the  ship's  side  and  affording 
phi  re  for  securing  small  boats;  also  used  in  hoisting  cargo  aboard. 

Bow — the  forward  end  of  the  ship. 

Boxing  the  compass     naming  the  points  of  the  compass  in  order. 

Bridge — an  elevated  platform  usually  extending  entirely  across  the 
ship  from  which  the  ship  is  controlled  while  under  way. 

Brig — the  ship's  prison. 

Brow — a  gangway  from  ship  to  a  nearby  dock. 

Bulkheads     vertical  walls  subdividing  the  ship's  interior. 

By  the  head     when  the  draft  of  a  ve— el  is  greater  forward  than  aft. 

By  the  stern — when  a  vessel  has  greater  draft  aft  than  forward. 

441 


442  NAVAL  HYGIENE 


Cabin— the  quarters  of  the  captain  or  admiral  on  board  a  man-o'- 
war.  This  term  is  applied  to  a  stateroom  on  a  passenger  steamer. 

Camel— a  float  to  prevent  a  vessel  from  striking  the  dock  when 
mooring. 

Capstan — a  drum  of  metal  rotating  vertically  or  horizontally  on  a 
central  spindle;  when  forced  to  run  it  may  lift  heavy  weights,  for 
instance  the  anchor. 

Catch  a  crab — to  catch  an  oar  in  the  water  the  wrong  way  when 
rowing. 

Clothes  stop — a  piece  of  white  line  tied  around  a  rolled  garment  to 
retain  the  roll.  Also  used  to  tie  garments  on  a  clothes  line. 

Coaming — the  raised  boundary  of  the  hatchway  which  prevents 
water  entering. 

Cofferdam — water-tight  cel]s  filled  with  cellulose.  These  usually 
are  placed  along  the  water-line  in  unarmored  positions.  If  a  shell 
strikes  and  water  enters,  the  corn  pith  swells  and  stops  the  leak. 

Conning  tower — a  structure  of  armor  1 2  or  15  inches  thick  to  protect 
the  commanding  officer  and  prevent  .destruction  of  communications 
and  steering  in  battle. 

Counter — that  portion  of  the  stern  extending  from  the  water-line 
to  the  overhang. 

Cutwater— the  forward  edge  of  the  stem  which  cuts  the  water  when 
the  ship  is  in  motion. 

D 

Davit — a  boom  or  out-rigger  which  projects  from  the  side  of  a  ship, 
used  for  hoisting  boats  or  heavy  weights. 

Dead  light — a  piece  of  heavy  glass  fixed  in  the  deck  or  side  to  admit 
light. 

Displacement — the  actual  weight  in  tons  displaced  by  a  ship. 

Ditty  box — a  box  used  for  keeping  toilet  articles,  writing  materials, 
etc. 

Dog  watch — a  watch  two  hours  long;  usually  a  watch  lasts  four 
hours  and  the  four-hour  period  from  4  to  8  is  divided  into  two  dog 
watches  in  order  that  the  watch  standers  will  rotate  in  their  watches. 

Double  bottom — the  space  between  the  inner  and  outer  bottom. 

Dungarees — working  clothes  made  of  heavy  blue  cotton  cloth. 


GLOSSARY   OF   NAUTICAL   TERMS    USED  443 

E 

Eyes  of  the  ship  —  the  extreme  forward  portion  of  a  ship. 

F 

Fall  —  a  line  run  through  a  block  for  hoisting  boats  or  weights. 

Field  day  —  general  cleaning  day,  usually  Saturday. 

Forecastle  —  that  portion  of  the  main  deck  between  the  foremast 
and  stem. 

Forward  —  the  first  of  the  three  dimensions  of  a  ship,  the  second 
being  midships,  and  the  third  the  after-part. 

Frames  —  the  ribs  rising  from  the  keel  to  form  the  body  of  the  ship. 
Plating  is  attached  to  them. 

G 

Galley  —  the  range  and  kitchen  aboard  ship. 
Go  about  —  change  the  tack  of  a  sailing  vessel. 
Ground  tackle  —  gear  used  to  moor  or  anchor  a  ship. 

H 

Halliards  —  the  lines  which  hoist  or  lower  the  top  mast  or  jib. 
Hammock  nettings  —  spaces  along  the  inner  side  of  the  ship  used 

for  slowing  the  hammocks  of  the  crew. 

Hatchway  -an  opening  in  the  deck  forming  a  passageway  from 
one  deck  to  another. 

Haul     to  pull  on. 

Hawse  holes—  holes  in  the  bow  for  the  ship's  cables  to  pass  through. 

Hawse  plug  plugs  fitted  in  the  hawse  holes  to  prevent  water 
coining  on  board  through  them;  when  made  of  canvas  or  stuffed  with 
oakum  are  culk'd  "Jack  a 

Heave  to      to  deaden  a  vessel's  headway. 

Holds  spares  in  the  forward  part  of  the  ship  in  which  the  gear  of 
the  ship  is  stowed. 


Irish  pennants     loo-e  ends  or  rope  yarns  depending  Irom  the  rigging 
deck. 


444  NAVAL   HYGIENE 

J 

Jacob's  ladder — a  rope  ladder  swinging  from  a  boom. 

K 

Keel- — first  piece  of  metal  or  timber  laid  in  building  the  ship. 

L 

Louver — an  opening  for  ventilation. 

Lucky  bag — a  place  in  which  articles  or  non-regulation  clothing 
are  put  after  confiscation  if  found  in  unauthorized  places.  Articles 
in  the  lucky  bag  which  are  not  claimed  are  sold  at  auction  from  time 
to  time. 

M 

Magazine — space  in  which  powder  is  stowed. 

Manger — part  of  the  main  deck  partitioned  off  to  prevent  water 
coming  through  the  hawse  holes  from  running  aft  over  the  decks. 

Mess  gear — eating  utensils. 

Midships — the  middle  part  of  the  ship.  Lies  between  forward  and 
after  parts. 

P 

Painter — the  line  leading  from  the  bow  of  a  small  boat  by  which  it 
may  be  made  fast. 

Pipe  down — a  boatswain's  call,  meaning  that  the  day's  work  is 
finished. 

Port— left  hand  side  of  a  ship  looking  forward. 

Ports — openings  in  the  ship's  side  for  various  purposes. 

R 

Rudder — the  apparatus  used  to  steer  a  vessel. 

S 


Screw — the  propeller. 

Scuppers — holes  in  the  waterways  through  which  water  is  conveyed 
overboard  through  pipes. 


. 


GLOSSARY   OF    XMIK  AL    TERMS    USED  445 

Scuttle — round  or  square  holes  in  the  deck  for  passage  of  coal  or 
-tores. 

Sea  ladder — steps  made  fast  on  the  ship's  side.  Used  for  coming 
on  board  when  the  accommodation  ladder  is  not  available. 

Sheet — a  line  which  is  used  to  set  a  sail  and  hold  it  in  position. 

Shrouds — lines  from  the  mast  head  to  the  rail. 

Sick  bay— the  ship's  hospital. 

Smoking  lamp — a  time  of  leisure  when  men  may  rest  or 
smoke. 

Spit  kid — a  cuspidor. 

Squilgee — a  piece  of  rubber  in  a  wooden  clamp  used  for  drying 
the  deck. 

Stanchions — vertical  pillars  of  wood  or  metal  supporting  some  other 
portion  of  the  ship. 

Starboard — the  right-hand  side  of  the  ship  facing  forward. 

Steerage — the  quarters  of  the  junior  officers. 

Steerage  way — the  lowest  rate  of  speed  at  which  a  ship  will  steer. 

Stem — vertical  extension  of  the  keel  to  which  the  plates  are 
attached. 

Stern — the  after-end  of  the  ship. 

Stern-post — the  vertical  extension  of  the  keel  to  which  the  stern 
plating  is  attached. 

Stop — to  secure  by  tying  with  a  small  cord. 

Storerooms — spaces  used  for  stowing  various  stores. 

Stretchers  movable  pieces  extending  across  the  bottom  of  the 
boat  against  which  the  oarsmen  may  brace  their  feet  in  pulling. 


ITaffrail — a  rail  around  a  vessel's  stern. 
Thwarts — seats  on  which  the  oarsmen  sit. 

Tiller — a  piece  of  timber  or  metal  fitted  fore  and  aft  to  the  rudder  to 
control  it. 

Trimming  tanks — lower  compartments  in  extreme  ends  of  a  ship, 
and  provided  with  sea  valves  for  filling  and  pump  suction  for  emptying. 
Truck     small  wooden  cap  covering  the  mast  head  or  the  top  of  a 
flagstaff. 

Turn-to— the  signal  for  work  to  begin. 


446  NAVAL   HYGIENE 

U 
Unship— to  remove  anything  from  where  it  has  been  made  fast. 

W 

Wardroom — the  quarters  of  officers  junior  to  the  captain,  but  senior 
to  the  junior  officers. 

Water-line — the  line  the  water  makes  on  the  ship's  side  when  she  is 
afloat. 

Water-tight  compartment — one  of  the  ship's  subdivisions  which 
may  be  made  water-tight. 

Waterways — gutters  extending  all  around  the  edge  of  the  upper 
deck. 

Wig-wag — a  system  of  signalling  with  a  flag. 

Wings — the  portions  of  the  hold  nearest  the  sides  of  the  ship. 


HYSICAL  EXAMINATION    OF  RECRUITS 


FOR  ENLISTMENT  IN   THE 

NAVY  AND  MARINE  CORPS 


The  following  instructions  for  physical  examination  of  recruits  for 
the  U.  S.  Navy  and  Marine  Corps  are  taken  from  a  circular  prepared  by 
Surgeon  H.  L.  Bollard,  U.  S.  N.,  for  the  use  of  student  officers  at  the 
U.  S.  Naval  Medical  School. 

They  are  based  upon  U.  S.  Navy  Regulations,  Instructions,  and 
Manual  for  the  Medical  Department. 

The  heavy  faced  numerals  indicate  an  article  of  corresponding 
number  in  the  Manual. 

Physical  Examination  of  Recruits  for  Enlistment  in  the  Navy  and  Marine  Corps 
2051.  Whenever  any  person  is  examined  physically  for  the  Navy  or  Marine 
Corps,  whether  subsequently  enlisted  or  rejected,  his  name  and  the  particulars  shall 
at  oice  be  entered  on  Form  X  (rough).  This  form  shall  be  prepared  for  each  appli- 
cant examined,  whether  accepted  or  rejected,  for  original  or  reenlistment,  and  will 
be  kept  for  the  purpose  of  preparing  Form  X.  It  shall  be  retained  for  ship  or  station 
files  and  shall  be  filed  alphabetically,  by  calendar  years,  according  to  the  applicant's 
surname,  in  order  that  information  may  be  furnished  the  bureau  upon  request. 

»]Je  careful  to  strike  through  with  ink  the  term  not  applicable  to  the  case. 
Form  X  shall  be  prepared  from  the  Form  X  (rough)  kept  for  the  purpose,  and 
will  be  forwarded  from  receiving  ships,  Navy  and  Marine  Corps  recruiting  stations, 
and  marine  recruit  depots  for  the  quarters  ending  March  31,  June  30,  September  30, 
and  December  31;  from  other  ships  and  naval  stations  or  yards  for  the  year  ending 
December  31,  or  when  a  ship  is  placed  out  of  commission  or  a  recruiting  or  other 
station  closed. 

A  copy  shall  be  retained  for  ship  or  station  files.  If  there  have  been  "No 
applicants,"  the  report  shall  be  forwarded  and  this  fact  so  stated  in  the  blank  spaces 
opposite  "\avy"  and  "Marine  Corps." 

Central  recruiting  stations  shall  include  in  their  report  the  sul»tations  and  travel- 
ing parties  coming  under  their  jurisdiction. 

Medical  officers  of  ships,  naval  stations,  or  yards  making  examinations  for  ships 
or  stations  to  which  no  medical  officer  is  assigned  shall  include  these  items  in  their 
reports. 

447 


448  NAVAL   HYGIENE 

Civilian  examiners  at  substations  of  the  Marine  Corps  will  prepare  and  forward 
Form  X  (rough)  to  the  central  stations. 

2052.  In  case  a  waiver  is  requested,  the  action  will  be  noted  on  Form  X  (rough) 
after  the  cause  of  rejection,  and  approval  of  waiver  shall  be  entered  on  this  form, 
and  also  in  the  service  and  health  records.     (R  3523  (3);  I  3209.) 

2053.  Marine  recruit  depots  shall  distinguish  between  "Accepted  applicants" 
transferred  from  recruiting  stations  to  the  depot  and  those  applying  originally  at 
the  depot  by  making  the  proper  entry  in  the  space  provided  on  this  form. 

2054.  Previous  Army  service  shall  not  be  considered  a  reenlistment.     Previous 
Navy  or  Marine  Corps  service  shall  be  considered  a  reenlistment  in  the  Navy,  and 
previous  Marine  Corps  or  Naval  service  shall  be  considered  a  reenlistment  in  the 
Marine  Corps,  so  far  as  it  applies  for  use  in  the  preparation  of  this  form. 

2055.  The  term  of  enlistment  of  all  enlisted  men  of  the  Navy  shall  be  four 
years,  except  minors  over  seventeen  and  under  eighteen  years  of  age,  who  shall  be 
enlisted  for  the  period  of  minority.     Minors  under  seventeen  cannot  enlist  in  the 
Navy.     No  enlistment  for  special  service  is  allowed. 

2056.  No  minor  under  the  age  of  eighteen  years  will  be  enlisted  without  the 
written  consent  of  the  parent  who  is  his  legal  guardian;  or,  if  both  parents  are 
dead,  of  a  legally  appointed  guardian. 

Minors  under  but  claiming  to  be  over  eighteen  years  of  age  are  liable,  if  en- 
listed, to  punishment  for  fraudulent  enlistment  under  the  act  of  Congress  approved 
March  3,  1893. 

2057.  Only  such  persons  shall  be  enlisted  as  can  reasonably  be  expected  to 
remain  in  the  service,  and  when  enlisted  must  serve  out  the  term  of  their  enlistment, 
and   cannot   be   discharged  prior  to  that  time,  except  for  cause  or  as  otherwise 
provided. 

2058.  Every  person  before  being  enlisted  must  pass  the  physical  examination 
prescribed  in  the  medical  instructions,  and  no  person  shall  be  enlisted  for  the  naval 
service  unless  pronounced  fit  by  the  commanding  and  medical  officers. 

2059.  No  person  other  than  a  medical  officer  shall  be  permitted  to  conduct  any 
part  of  a  physical  examination,  to  make  any  measurement,  or  to  make  any  original 
entry  on  any  medical  record  of  enlistment. 

2060.  Every  such  examination  must  be  completed  according  to  the  official  forms, 
and  shall  in  no  case  be  suspended  on  the  recognition  of  a  disqualifying  defect. 

2061.  Medical  officers  on  recruiting  duty  shall  exercise  great  care  and  thorough- 
ness in  conducting  the  physical  examination  of  persons  presenting  themselves  for 
enlistment.     While   these  instructions  are  applicable  in  general   to  all  physical 
examinations,  they  are  intended  to  cover  more  particularly  the  examinations  of 
applicants  presenting  themselves  for  original  enlistment.     While  permitted  to  use 
his  own  discretion  as  to  the  routine  of  procedure,  the  medical  officer  shall  make 
inquiry  on  all  points  indicated  below:  After  testing  the  vision,  color  perception,  and 
hearing,  and  estimating  the  general  fitness  of  the  applicant,  his  height,  weight,  am 
chest  measurements  may  be  taken  and  recorded,  the  clothing  having  been  remove 

A  general  inspection  and  regional  examination  is  then  made,  as  follows: 

(a)  The  applicant,  entirely  nude,  is  to  stand  before  the  examiner,  in  a  brighl 
light,  and  present  successively  front,  rear,  and  sides  (Retarded  development 
deformity  or  asymmetry  of  body  or  limbs,  knock-knees,  bow-legs,  or  fat  feet, 


APPENDIX  449 

especially  in  minors;  spinal  curvatures;  feebleness  of  constitution;  strumous  or  other 
cachcxia;  emaciation,  obesity;  cutaneous  or  other  external  disease;  glanduar  swell- 
ings or  other  tumors;  nodes;  varicosities,  cicatrices;  indications  of  medical  treat- 
ment, leech  bites,  blister  stains,  seton  or  scarification  scars;  and  evidences  of 
smallpox  or  successful  vaccination,  or  the  administration  of  salvarsan. 

(b)  Applicant  to  present  dorsal  and  palmar  surfaces  of  both  hands;  to  flex  and 
extend  every  finger;  to  grasp  with  thumb  and  forefinger  and  with  whole  hand;  to 
flex  and  extend,  pronate  and  supinate  wrists  and  forearms;  to  perform  all  the 
motions  of  shoulder  joints,  especially  circumduction;  to  extend  arms  at  right  angles 
to  body,  and  then  bend  elbow  and  touch  the  shoulders  with  the  fingers;  to  elevate 
extended  arms  above  the  head,  palm  to  palm,  then  dorsum  to  dorsum;  to  evert  and 
invert  the  feet;  to  stand  on  tiptoe,  coming  down  upon  the  heels  quickly,  and  then 
lifting  toes  from  floor;  to  flex  each  thigh  alternately  upon  the  abdomen,  and,  while 
standing  on  one  leg,  to  hop;  to  perform  all  the  motions  of  the  hip  joint;  and  to  walk 
backward  and  forward  slowly  and  at  double-quick. 

(c)  Note  effect  of  these  violent  exercises  on  the  heart  and  lungs;  observe  move- 
ments of  chest  during  prolonged  inspiration  and  expiration;  examine  by  percussion 
and  auscultation  front  and  rear.     (Incipient  tuberculosis,  valvular  disease.)     Care 
should  be   taken   to  differentiate  between  organic  murmurs  and  the  functional 
varieties. 

(d)  With  hands  on  the  head  and  chin  up,  applicant  to  cough  violently  (relaxation 
of  umbilical  and  inguinal  regions;  hernia;  concealed  venereal  disease,  especially 

•h  prepuce  and  within  urethra;  varicocele;  orchitis  and  other  abnormal  condi- 
tion >  of  testes). 

(e)  Applicant  to  bend  body  forward,  with  knees  stiffened,  feet  wide  apart, 
hands  touching  th2  floor,  and  nates  exposed  to  strong  light  (hemorrhoids,  pro- 
lapsus, fistulae).     While  the  applicant  is  stooping  make  firm  pressure  on  the  spinous 
process  of  each  vertebra  (noting  spinal  tenderness). 

(/)  Motions  of  head,  neck,  and  lower  jaw. 

(g)  Cranium  and  scalp  (malformations,  depressions,  cicatrices,  tinea,  vermin, 
etc). 

(h)  Ears  (polypi;  otorrhea,  perforation,  dullness  of  hearing,  and  degeneration 
sti}.;m 

(0   Mastoid  region  for  scars  or  tenderness. 

(j)    !  M-nce  of  cilia.-,  tarsal  redness,  obstructed  puncta,  corneal  opacities, 

adl  rsions  of  iris,  defective  vision,  abnormal  conditions  of  conjunctiva?,  trachoma, 
pterygium). 

(k)  Nose  (polypi;  ozena;  chronic  nasal  catarrh). 

(?)  Mouth,  teeth,  tongue,  fauces  (hypertrophied  tonsils;  syphilitic  affections, 
impediments  of  speech,  lingual  scars,  cleft  palate,  and  repulsive  stigmata  or  scars 
of  the  face,  grotesque  tattooing,  or  the  expression  characteristic  of  adenoids). 

2062.  Xo  educational  standard  has  been  officially  established  for  recruits  pre- 
serving them-elve-  for  enlistment  in  the  naval  MTVUV.  The  regulations  require, 
hovwer,  that  a  candidate  shall  be  able  to  read  and  write  and  that  he  should  possess 
a  r-asoiiably  quirk  and  clear  understanding.  Hi^  -eneral  intelligence  may  be 
estimated  by  hi>  manner  of  answering  the  questions  addressed  to  him  in  obtaining 
the  data  required  in  the  health  record,  and  any  impediments  of  speech  noted. 
29 


450  NAVAL  HYGIENE 

2063.  Section  1420  of  the  Revised  Statutes  forbids  the  enlistment  in  the  naval 
service  of  any  intoxicated  person.     The  evident  intention  of  the  law  was  not  only 
to  prevent  the  admission  into  the  service  of  men  who  at  the  time  of  presenting  them- 
selves for  enlistment  were  under  the  influence  of  alcoholic  stimulants  or  drugs,  but 
of  those  also  who  were  of  intemperate  habits.     A  thorough  inquiry  should  be  made 
into  the  history  of  any  applicant  in  which  habits  of  intemperance  are  suspected. 
Long  indulgence  in  habits  of  intemperance  will  be  indicated  by  persistent  redness 
of  the  eyes,  tremulousness  of  the  hands,  sluggishness  of  the  intellect,  satin-like  tex- 
ture of  the  skin  of  the  body,  an  eruption  upon  the  face,  and  purple  blotches  upon  the 
legs.     The  morphine  habitue  is  often  emaciated,  prematurely  senile,  with  foul  breath, 
contracted  pupils,  peculiar  pallor,  dry  skin,  and  often  showing  multiple  punctures 
of  the  skin  from  the  needle.     The  habitual  user  of  cocaine  may  be  suspected  when 
the  applicant  exhibits  unusual  buoyancy  and  mental  overactivity  accompanied  by 
irrelevant  volubility.     Cocaine  "snuffers"  will  usually  show  a  characteristic  hyper- 
emia  of  the  nasal  mucous  membrane.     Medical  officers  should  endeavor  to  eliminate 
the  insane,  vagrant,  and  criminal  classes  by  a  careful  study  of  the  personal  character- 
istics of  each  applicant.     Any  doubt  as  to  the  mental  stability  of  the  applicant  should 
determine  a  careful  investigation  directed  toward  his  previous  history. 

2064.  Certain  defects  which  are  frequently  found  associated  with  the  physical 
condition  in  cases  of  reenlistment  or  continuous  service  are  not  necessarily  causes  of 
rejection.     If  deemed  of  sufficient  importance  to  cause  rejection,  a  waiver  of  the 
defects  may  be  recommended,  provided  that  such  disabilities  will  not  interfere  with 
the  performance  of  duty.     Waiver  is  requested  on  "Report  of  Rejection,"  procur- 
able from  Bureau  of  Navigation  (Form  No.  54).     This  report  shall  be  forwarded  in 
all  cases  of  physical  rejection  of  continuous-service  men.     (R.  3528.)     Physical 
infirmities  incident  to  advanced  years  and  long  service  should  be  carefully  considered 
in  these  examinations  and  especially  in  the  case  of  reenlistment  under  continuous 
service.     Slight  physical  defects  in  those  applicants  who  have  matured  are  of  less 
importance  than  when  occurring  in  minors. 

Physical  disqualifications  of  a  minor  nature  of  probably  temporary  duration 
readily  amenable  to  medical  or  surgical  treatment  should  not  necessarily  cause 
rejection,  if  the  candidate  is  otherwise  qualified  and  desirable.  Application  will 
be  made  to  the  bureau  for  the  admission  to  hospital  of  such  cases  as  supernumeraries 
for  treatment  of  such  duration  as  may  be  desirable,  having  in  view  the  removal  of 
disqualifying  defects  and  the  ultimate  enlistment  of  a  candidate  who  is  in  all  other 
respects  qualified.  In  stating  the  cause  of  rejection  in  such  cases  ambiguous  terms 
should  be  avoided  and  the  degree  of  visual  and  auditory  defects  should  be  given. 
(M.  and  S.  No.  123734.) 

2065.  The  examining  surgeon  shall  consider  carefully  the  physical  adaptability 
of  the  applicant  in  relation  to  the  character  of  the  duties  which  he  may  be  called 
upon  to  perform.     Moderate  height  and  compact  build  are  requisite  in  the  ratings 
of  fireman  and  coal  passer.     The  duties  pertaining  to  these  ratings  are  extremely 
arduous,  and  applicants  for  such  positions  and   candidates  for  transfer  to  these 
ratings  must  conform  in  every  particular  to  the  required  physical  standard.     As  a 
general  rule  minors  should  not  be  recommended  for  the  ratings  of  fireman  and  coal 
passer. 


. 


APPENDIX  451 


2066.  Slight  physical  defects  in  applicants  who  belong  to  the  sea-faring  class,  or 
ho-e  who  have  had  experience  in  military  life,  have  less  significance  than  they 

crwi-e  have  in  the  cases  of  recruits  who.-c  live.-  have  been  passed  in  occupa- 
tion- <>f  a  more  confining  and  debilitating  character.  In  the  latter  class  of  candi- 
date the  unusual  and  peculiar  services  that  would  necessarily  be  exacted  of  them 
mijiht  develop  any  weakness  or  constitutional  physical  traits  that  existed  prior  to 
enlistment. 

2067.  While  it  is  not  expected  that  candidates  for  special  ratings  should  possess 
the  physique  and  endurance  of  those  actively  engaged  in  strictly  military  duties, 
the  examining  surgeon  should  remember  that  all  candidates  examined  for  the  several 
special  ratings  are  enlisted  for  the  performance  of  all  duties  pertaining  to  the  naval 
sen  ice  ashore  and  afloat. 

2068.  The  examining  surgeon  should  consider  carefully  the  physiognomy  of  the 
candidate.     Where  the  applicant's  face  is  marked  by  great  deformity,  warts,  or 
extensive  birthmarks,  he  shall  be  considered  undesirable  for  the  service  and  shall  be 
rejected. 

2069.  The  examining  surgeon  shall  exercise  the  greatest  care  in  the  examination 
of  the  candidate's  feet.     Pronounced  flat  foot,  loss  or  deformity  of  the  large  toe,  or 
of  fvo  of  the  smaller  toes  on  one  or  both  feet,  partial  ankylosis  of  the  ankles,  marked 
callosities  or  ingrowing  toenails,  and  any  other  defects  which  in  the  opinion  of  the 
examining  surgeon  may  interfere  with  marching  or  prolonged  sentry  or  deck  duty 
shall  be  considered  causes  for  rejection  of  the  applicant. 

2070.  The  absence  of  or  the  marked  deformity  of  the  right  index-finger  or  thumb 
shall  cause  the  rejection  of  the  applicant.     The  importance  attached  to  the  absence 
of  or  deformity  of  the  left  index-finger  or  thumb  will  depend  upon  the  adaptability 
of  tie  applicant  for  his  special  rating,  and  provided  that  he  is  otherwise  physically 
sound. 

?.<>7i.  In  determining  the  weight  to  be  attached  to  slight  degrees  of  varicocele, 
vari  ose  veins,  and  hemorrhoids,  the  examining  surgeon  shall  carefully  consider  the 
age.  the  general  physique,  and  the  rating  of  the  applicant.  All  candidates  with 
hyd.-ocele  shall  be  rejected,  also  all  candidates  with  varicocele  when  accompanied  by 
atrophy  of  the  testes,  pain,  or  an  evident  neurotic  state. 

2072.  Marked  enlargement  in  either  testicle  or  the  absence  of  both  testicles 
shal!  cause  the  rejection  of  the  applicant.     Applicants  whose  clothing  exhales  the 
odor  of  urine,  or  who  present  any  evidences  of  incontinence  of  urine,  shall  be  rejected. 

:>ispadias  and  hypospadias  shall  be  rejected. 

2073.  I'.very  recruit  mu-t  have  at  least  20  sound  teeth,  and  of  these  not  less  than 
4  oppo-ed  incisors  and  4  opposed  molar-;  but,  if  otherwise  qualified  and  desirable, 
a  waiver  may  be  requested  in  the  case  of  a  candidate  not  having  4  opposed  incisors 
and  4  opposed  molars. 

2074.  The  examination  for  visual  acuteness  is  of  the  utmost  importance  and 
shall  be  conducted  by  the  medical  officer  with  the  greatest  care  and  patience.     An 
appreciable  percentage  of  men  are  the  subjects  of  slight  visual  defects,  and  in  the 
cases  of  many  of  those  presenting  them-elve-  for  reenli-tment  and  enlistment  these 
defects  may  not  be  sufficiently  serious  to  disqualify  them  for  the  naval  service.     The 
igno-ance,  fear,  or  stupidity  on  the  part  of  an  applicant  undergoing  examination 


452  NAVAL  HYGIENE 

should  be  taken  into  consideration  by  the  examining  surgeon,  and  unless  the  exami- 
nation is  conducted  with  care  and  deliberation  an  applicant  may  be  rejected  whose 
vision  is  really  good.  Slight  errors  on  the  part  of  the  applicant,  such  as  misreading 
a  P  or  T  for  an  F,  provided  the  majority  of  the  letters  or  test  characters  are  read 
with  facility,  need  not  be  sufficient  cause  for  rejection.  The  examination  shall  be 
conducted  in  a  large  well-lighted  apartment,  and  the  test  cards  shall  be  placed  in  a 
good  light.  The  applicant  stands  at  a  distance  of  20  feet,  one  eye  being  tested  at  a 
time,  and  the  other  covered  by  a  card.  Vision  is  to  be  expressed  as  a  fraction,  of 
which  the  numerator  shall  be  the  distance  at  which  Snellen's  20-foot  test  can  be 
determined  and  the  denominator  20.  Normal  vision  (20/20)  for  each  eye,  tested 
separately,  shall  be  required,  but  in  candidates  who  are  otherwise  physically  sound  a 
minimum  visual  acuteness  of  15/20  shall  suffice.  The  existence  of  several  minor 
defects,  combined  with  a  visual  acuteness  of  15/20  in  each  eye,  shall  cause  the 
rejection  of  the  applicant. 

2075.  Color  perception  is  to  be  carefully  determined.     The  usual  examination 
is  by  Holmgren's  method,  which  may  be  briefly  described  as  follows:  The  worsteds 
are  placed  in  a  pile  in  the  center  of  a  white  surface  in  good  daylight.     The  green  test 
skein  is  placed  aside  upon  the  white  cloth,  and  the  person  to  be  examined  is  directed 
to  select  the  various  shades  of  the  same  color  from  the  pile  and  place  them  by  the 
sides  of  the  sample.     The  color  blind  will  make  mistakes  in  the  selection  of  the 
shades;  or  a  hesitating  manner  with  a  disposition  to  take  the  wrong  shades  may 
show  a  feeble  chromatic  sense.     The  purple  test  skein  is  then  used.     If  the  test  with 
the  green  skein  has  shown  the  person  examined  to  be  color  blind,  and  on  the  second 
or  purple  test  he  selects  only  the  purple  skeins,  he  is  incompletely  color  blind;  but 
if  he  places  with  the  purple  shades  of  green  or  gray,  he  is  completely  green  blind. 
The  red  test  skein  need  not  necessarily  be  used,  but  it  may  be  employed  to  confirm, 
the  diagnosis  already  made;  for  the  red  blind  will  select,  to  match  the  red  skein, 
shades  of  green  or  brown  which  to  the  normal  sense  seem  darker  than  the  red, 
while  the  green  blind  will  select  the  shades  of  green  or  brown  which  seem  lighter. 

2076.  The  organs  of  hearing,  both  the  conducting  apparatus  (outer  and  middle 
ear)  and  the  percipient  apparatus  (internal  ear)  must  be  free  from  disease.     In 
testing  the  hearing  of  the  applicant  advantage  should  be  taken  of  the  absence  of 
other  sounds  to  make  the  examination.     Medical  officers  should  remember  that  the 
applicant  may  be  totally  deaf  in  one  ear  and  yet  may  hear  all  ordinary  conversation 
perfectly  if  the  sound  ear  is  not  completely  closed.     Deafness  may  be  caused  by  an 
accumulation  of  hardened  wax,  therefore  an  otherwise  desirable  recruit  should  have 
his  ears  well  cleaned  before  final  action  is  taken  in  his  case.     Hearing  shall  be 
expressed  as  a  fraction,  of  which  the  numerator  shall  be  the  distance  in  inches  at 
which  the  ticking  of  an  ordinary  watch  can  be  heard,  and  the  denominator  40.     If 
the  voice  is  used,  hearing  shall  be  expressed  as  a  fraction,  of  which  the  numerat< 
shall  be  the  distance  in  feet  at  which  the  voice  of  the  examiner  can  be  heard  and  tl 
denominator  15.     The  voice  is  a  more  reliable  method  of  determining  the  acutem 
of  hearing  than  the  watch  test,  as  it  allows  for  variations  in  hearing  with  the  modiJ 
cations  produced  by  changes  in  pitch  and  tone.     Complete  deafness  in  either 
shall  be  considered  a  sufficient  cause  for  rejection.     Before  completing  the  examinj 
tion  the  medical  officer  shall  satisfy  himself  of  the  patency  of  the  eustachi.in  tul 
and  the  integrity  of  the  tympanic  membranes. 


APPENDIX  453 

2078.  In  every  case  of  rejection,  the  disability  unfitting  the  applicant  for  service, 
and  in  other  cases  any  abnormal  condition,  former  grave  illness,  or  serious  injury 
not  inconsistent  with  present  bodily  vi<,'or  shall  be  entered  on  Form  X  (rough). 

2079.  Recruits  presenting  themselves  for  enlistment  in  the  naval  service  shall 
be  rejected  by  the  examining  surgeon  for  any  one  of  the  following  conditions: 

General  Disqualifications 

(a)  Mental  Infirmities. — Insanity,  idiocy,  imbecility,  dementia. 

(b)  Moral  Infirmities. — Intemperance  in   the  use  of  stimulants  or  narcotics, 
evidence  of  felony,  masturbation,  sodomy. 

(c)  Diseases  of  the  Cerebro-spinal  System. — Epilepsy,  chorea,  all  forms  of  paralysis, 
tabes  dorsalis,  neuralgia,  stuttering. 

(d)  Constitutional  Diseases. — Feebleness  of  constitution  (poor  physique),  syphilis. 


(e)   The 


Special  Disqualifications 


(e)  The  Skin. — All   chronic,   contagious,   and   parasitic  diseases   of   the   skin, 
e.v.ensive  nevi,  deep  and  adherent  cicatrices,  chronic  ulcers,  vermin. 

(f)  The  Head. — Abnormally  large   head;   considerable  deformities,  the  conse- 
quence of  fracture;  serious  lesions  of  the  skull,  the  consequence  of  complicated 
we  unds  or  the  operation  of  trephining;  caries  and  exfoliation  of  the  bone,  injuries  of 
cranial  nerves,  tinea  capitis,  alopecia. 

(g)  The  Spine. — Caries,  spina  bifida,  lateral  or  angular  curvatures  of  the  cervical, 
dorsal,  or  lumbar  regions;  lumbar  abscess,  rickets,  fracture  and  dislocation  of  the 
ve-tebrae,  angular  curvatures,  including  gibbosity  of  the  anterior  and  posterior  parts 
of  the  thorax. 

(ti)  The  Ears. — Deafness  of  one  or  both  ears,  all  catarrhal  and  purulent  forms  of 
acute  and  chronic  otitis  media,  polypi  and  other  growths  or  diseases  of  the  tym- 
panum, labyrinth,  or  mastoid  cells;  perforation  of  the  tympanum;  closure  of  the 
auditory  canal,  partial  or  complete,  except  from  acute  abscess,  furuncle,  or  impacted 
cerumen;  malformation  or  loss  of  the  external  ear  and  all  diseases  thereof,  except 
those  which  are  slight  and  non-progressive. 

(»')  7 '//»•  /  .  I  .<  -s  of  eye,  total  loss  of  sight  of  either  eye,  conjunctival  affections, 
including  trachoma,  entropion;  opacities  of  the  cornea,  if  covering  a  part  of  a 
moderately  dilated  pupil;  pterygium,  if  extensive;  strabismus,  hydrophthalmia, 
exophthalmia,  conical  cornea,  cataract,  loss  of  crystalline  lens,  diseases  of  the 
lacrimal  apparatus,  ectropion,  ptoxjs.  incessant  spasmodic  motion  of  the  lids,  ad- 
hesion of  the  lids,  l;tri:e  en.  y>ted  tumors,  abscess  of  the  orbit,  muscular  asthenopia, 
:mus.  Any  affection  of  the  globe  of  the  eye  or  its  contents;  defective  vision, 
including  anomalies  of  accommodation  and  refraction;  myopia,  hypermetropia,  if 
accompanied  by  asthenopia.  a-ti-matism,  amblyopia,  glaucoma,  diplopia,  color 
blindness. 

0')  The  Face. — Extensive  nevi,  unsightly  hairy  spots,  extensive  cicatrices  on  the 
face. 

(k)  The  Mouth  and  Fauces. — Harelip,  simple,  double,  or  complicated;  loss  of  the 


454  NAVAL  HYGIENE 

whole  or  considerable  part  of  either  lip;  unsightly  mutilation  of  the  lips  from 
wounds,  burns,  or  disease;  loss  of  the  whole  or  part  of  either  maxilla,  ununited 
fractures,  ankylosis,  deformities  of  either  jaw  interfering  with  mastication  or 
speech,  loss  of  certain  teeth,  cancerous  or  erectile  tumors,  hypertrophy  or  atrophy 
of  the  tongue,  mutilation  of  the  tongue,  adhesion  of  the  tongue  to  any  parts,  pre- 
venting its  free  motion;  malignant  diseases  of  the  tongue,  chronic  ulcerations, 
fissures  or  perforations  of  the  hard  palate,  salivary  or  bucconasal  and  thyroglossal 
fistulae,  hypertrophy  of  the  tonsils  sufficient  to  interfere  with  respiration  or  phona- 
tion,  pyorrhoea. 

(/)  The  Neck. — Goiter,  adenitis  of  the  cervical  glands,  tracheal  openings,  thy- 
roglossal or  cervical  fistulae,  wry  neck,  chronic  laryngitis,  or  any  other  disease  of 
the  larynx  which  would  produce  aphonia,  stricture  of  the  esophagus. 

(m)  The  Chest.- — Malformation  of  the  chest,  or  badly  united  fractures  of  ribs  or 
sternum  sufficient  to  interfere  with  respiration;  caries  or  necrosis  of  ribs,  deficient 
expansive  mobility,  evident  predisposition  to  tuberculosis,  chronic  pneumonia, 
emphysema,  chronic  pleurisy,  pleural  effusions,  chronic  bronchitis,  asthma,  organic 
disease  of  the  heart  or  large  arteries,  serious  protracted  functional  derangement  of 
the  heart. 

(n)  The  Abdomen. — All  chronic  inflammations  of  the  gastro-intestinal  tract, 
including  diarrhea  and  dysentery;  diseases  of  the  liver  or  spleen,  including  those 
caused  by  malarial  poisoning,  ascites,  obesity,  dyspepsia,  if  confirmed;  hemor- 
rhoids, prolapsus  ani,  fistula  in  ano,  considerable  fissures  of  the  anus,  hernia  in  all 
situations. 

(0)  Genito-urinary  Organs. — Any  acute  affection  of  the  genital  organs,  including 
gonorrhea,  syphilis,  and  venereal  sores;  loss  of  the  penis,  phimosis,  if  complete, 
stricture  of  the  urethra,  loss  of  both  testicles,  undescended  testicle  or  permanent 
retraction  of  one  or  both  testicles,  chronic  disease  of  the  testicle  or  epididymitis, 
hydrocele  of  the  tunic  and  cord  unless  the  hydrocele  of  the  cord  is  small  and  incon-  • 
sequent,  atrophy  of  the  testicle,  varicocele,  malformations  of  the  genitalia,  epispa- 
dias,  hypospadias,  but  a  slight  degree  of  hypospadias  not  preventing  the  normal  j 
passage  of  urine  may  not  cause  rejection;  incontinence  or  retention  of  urine,  urinary   \ 
fistulae,  enlargement  of  the  prostate,  calculus,  cystitis,  and  all  organic  diseases  of   j 
the  kidney. 

(P)  Affections  Common  to  Both  the  Upper  and  Lower  Extremities. — Chronic  rheuma- 
tism, chronic  diseases  of  joints  or  movable  cartilage,  old  or  irreducible  dislocations  or  | 
false  joints,  severe  sprains,  relaxation  of  the  ligaments  or  capsules  of  joints,  disloca- 
tions, fistulae  connected  with  joints  or  any  part  of  bones,  effusions  into  joints,  badly   , 
united  or  non-united  fractures,  defective  or  excessive  curvature  of  the  long  bones,    | 
rickets,  caries,  necrosis,  exostoses,  atrophy  or  paralysis  of  a  limb;  extensive,  deep,   j 
or  adherent  cicatrices,  especially  of  burns,  contraction  or  permanent  retraction  of  a   j 
limb  or  portion  thereof,  loss  of  a  limb  or  portion  thereof,  inequality,  deformities. 

(q)  The  Upper  Extremities.— Fracture  of  the  clavicle,  fracture  of  the  radius  and 
ulna,  webbed  fingers,  permanent  flexion  or  extension  of  one  or  more  fingers,  as  well  ' 
as  irremediable  loss  of  motion  of  these  parts;  mutilation  or  loss  of  either  thumb,  total  1 
loss  of  the  index-finger  of  the  right  hand,  loss  of  the  second  and  third  phalanges  of  j 
all  fingers  of  either  hand,  total  loss  of  any  two  fingers  of  the  same  hand. 


APPENDIX 


455 


(r)  The  I.inci-r  Extremities. — Varicose  veins,  knock-knees,  clubfeet,  flat  feet, 
webbed  toes,  tlu-  toes  double  or  branching,  the  great  toe  crossing  the  other  toes, 
hammer  toe.  bunions,  corns,  overriding  or  superposition  of  any  of  the  toes  to  an 
extreme  degree,  loss  of  a  great  toe,  loss  of  any  two  toes  of  the  same  foot,  permanent 
retraction  of  the  last  phalanx  of  any  of  the  toes,  or  flexion  at  a  right  angle  of  the  first 
phalanx  of  a  toe  upon  the  second,  with  ankylosis  of  the  articulation;  ingrowing 
of  the  nail  of  the  great  toe,  bromidrosis. 

(a) — TABLE  OF  PHYSICAL  PROPORTIONS  FOR  HEIGHT,  WEIGHT  AND 
CHEST  MEASUREMENT  OF  ADULTS 

[Bureau  of  Navigation  Circular  relating  to  the  enlistment  of  men,  July  20,1912] 


Height 

Weight 

Chest 
(mean 
circum- 
ference) 

Inches 

Pounds 

Inches 

64 

128 

33 

65 

I30 

33 

66 

I32 

33^2 

67 

134 

34 

68              141 

34^ 

69 

148 

34** 

70 

155 

35% 

71 

162 

36 

72 

169 

36^ 

73              176          36% 

(b)—  T  \HI  i;  OF  PHYSIC  \i.  PROPORTIONS  FOR  ENLISTMENT  OF  FILIPINOS 


Chest 

Age 

Height 

Weight 

measure- 
ment 

Expansion 

(mean) 

18  to  io 

6l 

105 

30« 

2 

20  to   .'I 

62 

108 

31 

2^4 

and 

62>i 

no 

31^        *M 

over. 

2081.  The  minimum  height  for  acceptance  of  a  man  twenty-one  years  old  or 

over  is  04  inches  barefooted.  A  variation  not  exceeding  i  inch  is  permissible  if 
the  applicant  is  in  good  health  and  desirable  as  a  recruit.  The  minimum  weight 
for  acceptance  of  a  man  twenty  one  years  old  i-  128  pounds.  A  variation  of  IO 
pounds,  not  to  fall  below  i  jS  pounds  in  weight  or  j  inches  in  chest  measurement 
l)t low  the  standard  given  in  the  table  is  admissible  when  the  applicant  for  enlist- 
ment is  active,  has  firm  muscles,  and  i-  evidently  vigorous  and  healthy,  except  for 
enlistment  in  the  rate  of  coal  passer,  for  which  rate  full  standard  measurements  will 
be  required.  A  chest  expansion  of  less  than  2  inches  in  a  minor,  or  of  less  than 


456 


NAVAL   HYGIENE 


2}^  inches  in  an  adult,  is  a  sufficient  cause  for  rejection  of  an  applicant.     The  table 
is  given  to  show  what  is  regarded  in  deciding  upon  the  acceptance  of  recruits. 

2082.  A  minor  enlisting  as  apprentice  seaman  must  conform  to  the  standards 
noted  in  the  following  table,  which  is  also  applicable  to  apprentice  musicians,  United 
States  Marine  Corps,  and  to  midshipmen.  (Circular  of  July  20,  1912.) 


Minimum 
height 

Minimum 
weight 

Chest 
expansion 

At  17  years  of  age 

Inches 
62 

Pounds 
I  IO 

Inches 
2 

At  1  8  years  of  age  

64 

lie 

2 

At  19  years  of  age. 

64 

1  2O 

2 

At  20  years  of  age  

64 

12? 

2 

(If  the  age  is  six  months  in  excess  of  a  full  year  the  requirements  are  those  of 
the  age  at  the  next  birthday.) 

(No  underweight  or  underheight  is  allowed  in  minors.) 

2083.  Marked  disproportion  of  weight  over  height  is  not  a  cause  for  rejection 
unless  the  applicant  is  positively  obese. 

2084.  Any  one  of  the  following  conditions  will  be  sufficient  to  cause  the  rejection 
of  an  applicant  (Bureau  of  Navigation  Circular,  1916) : 

(a)  Feeble  constitution,  general  poor  physique,  or  impaired  general  health. 

(b)  Any  disease  or  deformity,  either  congenital  or  acquired,  that  would  impair 
efficiency,  such  as:  Weak  or  deranged  intellect,  cutaneous  disease  not  of  a  mild  type, 
parasites  of  the  skin  or  its  appendages,  deformity  of  the  skull,  abnormal  curvature  of 
the  spine,  torticollis,  inequality  of  upper  or  lower  extremities,  inefficiency  of  joints 
or  limbs,  deformity  of  joints  or  bones  (either  congenital  or  the  result  of  disease  or 
injury),  evidence  of  epilepsy  or  other  convulsions,  defective  vision  (minimum  ^o 
S.  in  either  eye),  disease  of  the  eye,  color  blindness,  impaired  hearing  or  disease  of 
the  ear,  chronic  nasal  catarrh,  ozena,  polypi,  great  enlargement  of  the  tonsils,  impedi- 
ment of  speech,  disease  of  heart  or  lungs  or  predisposition  to  such  disease,  enlarged 
abdominal  organs  or  evidence  of  cirrhosis,  tumors,  hernia,  undescended  testicle, 
large  varicocele,  sarcocele,  hydrocele,  stricture,  fistula,  hemorrhoids,  large  varicose 
veins,  disease  of  the  genito-urinary  organs,  chronic  ulcers,  ingrowing  nails,  bad 
corns,  large  bunions,  deformity  of  toes,  loss  of  many  teeth,  or  teeth  generally  un- 
sound (teeth  properly  filled  not  to  be  considered  unsound).     Every  recruit  must 
have  at  least  20  sound  teeth. 

(c)  Any  acute  disease. 

2085.  (a)  Each  recruit  shall  be  required  to  take  the  oath  of  allegiance,  and  further 
state  that  the  statement  he  makes  regarding  his  date  of  birth  and  previous  naval  or 
other  military  service  is  correct,  and  that  he  is  not  subject  to  fits,  has  no  disease  con- 
cealed or  likely  to  be  inherited,  and  has  no  stricture  or  internal  piles.     The  examining 
surgeon  certifies  on  the  service  record  as  follows:  "I  certify  that  I  have  carefully 
examined,  agreeably  to  the  Regulations  of  the  Navy,  the  above-named  recruit,  and 
find  that,  in  my  opinion,  he  is  free  from  all  bodily  defects  and  mental  infirmity  which 


APPENDIX  457 

would  in  any  way  disqualify  him  from  performing  the  duties  of  his  rating,  and  that 
he  has  stated  to  me  he  has  no  disease  concealed  or  likely  to  be  inherited." 

0)  (i)  On  account  of  insufficient  or  inaccurate  information  in  reports  of  rejection 
as  to  physical  defects  of  applicants  for  enlistment,  the  bureau  is  frequently  unable  to 
determine  whether  such  defects  should  be  waived,  and  such  reports  are  often  returned 
for  further  information  before  recommendation  can  be  made. 

(2)  When  a  defect  is  curable  by  minor  operation,  the  medical  examiner  should  so 
state  and  also  whether  the  applicant  agrees  to  operation  if  necessary. 

(3)  In  reporting  rejections  for  any  of  the  following  defects  the  bureau  desires 
that  the  information  as  noted  below  be  given: 

(4)  Flat  Foot. — Give  degrees  of  flatness,  stating  accurately  the  distance  between 
the  tubercle  of  the  scaphoid  and  the  line  from  the  lower  border  of  the  internal 
malleolus  to  the  lower  tubercle  on  the  head  of  the  first  metatarsus.     The  measure- 
ment should  be  taken  standing  with  the  weight  of  the  body  on  that  foot  and  when 
the  foot  is  at  a  right  angle  to  the  leg  and  the  second  toe  is  on  a  line  with  the  crest  of 
the  tibia.     The  size  of  the  shoe  should  also  be  given.     The  width  of  the  bah1  of  the 
foot  should  be  given  and  any  tendency  to  talipes  valgus  noted. 

(5)  Bunions,  hammertoes,  corns,  and  ingrowing  toenails  should  be  described 
accurately  as  to  location,  degree,  etc. 

(6)  Varicocde. — State  size  and  indicate  by  small,  medium,  or  large. 

(7)  Varicose   Veins. — State  location,  extent,  and  size  and  indicate  by  small, 
medium  or  large. 

(8)  Hemorrhoids. — State  character  and  size  and  indicate  by  small,  medium,  or 

(9)  Hydrocele. — State  size  and  indicate  by  small,  medium,  or  large. 

(10  Hernia. — State  location,  size,  and  whether  incipient,  incomplete,  or  complete. 
Relaxed  rings  only  are  not  cause  for  rejection  unless  abdominal  walls  are  weak  or 
there  is  a  decided  impulse  on  coughing. 

(n)  Deformities. — State  location,  character,  degree,  and  amount  of  interference 
with  motion. 

(12)  Contraclures. — State  location,  degree,   and  amount  of  interference  with 
motion. 

(13)  Stiff  Joint. — State  location,   degree  of  flexion  and  extension  obtainable 
and  the  strength  of  the  part. 

(14  State  degree,  giving  distance  by  watch,  by  the  whispered 

and  spoken  voice,  stating  whether  lie  can  readily  hear  ordinary  conversation.  State 
condition  of  the  external  canals  and  drums. 

(15  :on. — State  defect  accurately,  whether  due  to  refractive  error 

or  other  disease;  when  practicable,  giving  correction  by  lenses. 

(16)  Missing  or  Defective  Teeth. — State  in  detail  those  missing  or  unerupted  and 
those  defective,  u-ing  diagram  for  that  purpose.     Also  state  whether  teeth  will  admit 
o!  proper  repair. 

(17)  Deficient  Height  or  Weight.  -Always  state  age.  height,  and  weight. 

(18)  Tachycardia.     State   cause,   character,   and    duration,   giving   time  during 
examination  for  applicant  to  recover  from  excitement  or  overexertion. 

(19)  Spinal  Curvature. — State  location,  character,  and  degree. 


458  NAVAL  HYGIENE 

(20)  Atrophy  or  Hypertrophy  of  Testicle. — State  degree  and  cause. 

2086.  (a)   Recruits  shall  be  vaccinated  within  twenty-four  hours  after   their 
arrival  on  a  receiving  ship  or  at  a  barracks.     In  case  of  failure  the  operation  shall 
be  repeated  in  eight  days.     If  the  second  vaccination  is  not  successful  it  shall  be 
repeated  at  the  first  opportunity  with  a  vaccine  of  assured  potency.     The  only 
acceptable  evidence  of  successful  vaccination  is  a  pitted  scar  following  vaccination. 
Results  of  vaccination  shall  be  recorded  on  the  health  record  and  reported  on  the 
quarterly  report  of  sick. 

(b)  No  recruit  in  the  Navy  or  Marine  Corps  shall  be  transferred  from  a  training 
station,  receiving  ship,  barracks,  or  other  rendezvous  until  the  medical  officer  is 
satisfied  that  the  man  is  protected  against  smallpox. 

(c)  Every  enlisted  man  of  the  Navy  or  Marine  Corps  shall  be  vaccinated  upon 
reenlisting,  or  extending  enlistment,  unless  (a)  he  has  two  pitted  vaccination  scars, 
or  (b)  shows  evidence  of  a  previous  attack  of  smallpox. 

(d)  Every  officer  should  be  vaccinated  upon  appointment  immediately  upon 
reporting  at  his  first  station  for  duty,  and  the  fact  entered  on  his  health  record. 
Revaccination  should  be  performed  at  least  once  in  every  seven  years  thereafter 
unless  he  has  two  pitted  vaccination  scars,  or  evidence  of  a  previous  attack  of  small- 
pox.    The  responsibility  for  re  vaccination  shall  rest  upon  the  medical  officer  making 
the  annual  physical  examination  required  by  I  709  (5).     If  it  is  impracticable  for 
this  medical  officer  to  perform  the  vaccination,  he  shall  notify  the  proper  medical 
officer,  through  official  channels,  so  that  it  may  be  carried  out.     The  medical  officer 
who  performs  the  vaccination  shall  note  the  result  of  the  vaccination  on  the  officer's 
health  record.     (I  3211.) 

2087.  (a)  Typhoid  prophylactic  shall  be  administered  to  all  persons  upon  their 
first  entry  into  the  Navy  or  Marine  Corps. 

(6)  It  shall  be  administered  to  each  enlisted  man  upon  each  subsequent  enlist- 
ment, or  extension  of  enlistment,  who  is  under  forty-five  years  of  age,  or  who  has  not 
had  a  well-defined  case  of  typhoid  fever.  The  medical  officer  making  the  physical 
examination  at  the  time  of  reenlistment  shall  start  the  administration,  if  practica- 
ble; if  not,  he  shall  notify  the  proper  medical  officer,  through  official  channels,  so 
that  the  administration  may  be  completed. 

(c)  The  administration  of  typhoid  prophylaxis  should  be  repeated  after  a  period 
of  four  years  for  all  persons  in  the  Navy  or  Marine  Corps  who  are  under  forty-five 
years  of  age,  or  who  have  not  had  a  well-defined  case  of  typhoid  fever,  and  the 
medical  officer  making  the  annual  physical  examination  required  by  Article  I  709  (5) 
shall  be  responsible  for  its  administration.     If  it  is  impracticable  for  him  to  give  the 
prophylactic,  he  shall  notify  the  proper  medical  officer,  through  official  channels,  so 
that  it  may  be  given. 

(d)  The  only  acceptable  evidence  of  administration  of  the  prophylactic  shall  be 
the  entry  on  the  health  record,  signed  by  the  medical  officer.     (I  3212.) 

2088.  Medical  officers  are  required  by  act  of  February  16,  1914,  to  conduct  a 
physical  examination  of  men  of  the  Naval  Militia  when  mustered  into  service  of  the 
United  States.     (General  Order  No.  150,  June  14,  1915.) 

2089.  When  available,  medical  officers  will  make  such  examinations  of  members 
of  the  Naval  Auxiliary  Service  as  are  prescribed  in  the  regulations  for  that  service 


APPENDIX  459 

Instructions  to  be  Observed  in  Opening  and  Preparing  Health  Records 

2241.  (<;)  The  whole  name  (Christian,  middle,  and  surname),  to  correspond  with 
t  lat  on  service  record  and  to  be  legibly  written  out,  without  abbreviations,  and 
correctly  spelled,  preference  being  given  to  the  original  spelling  of  foreigners'  names, 
the  surname  to  precede  and  to  be  distinguished  by  being  underlined. 

(6)  As  far  as  possible,  on  reports  and  returns,  the  grades  and  rates  of  officers 
and  men  should  be  spelled  out  in  full,  but  where  sufficient  space  is  not  provided  the 
abbreviations  in  par.  2241  (b)  of  the  manual  should  be  used. 

(r)   Enter  the  rating  in  which  actually  enlisted. 

(</)  Enter  the  name  of  the  place  where  enlisted. 

(e)  Enter  date  actually  enlisted  and  strike  out  the  term  not  to  be  used  as  not 
applying  in  the  case  of  the  man  under  consideration,  following  the  date  of  enlistment. 

(0  Enter  month,  day,  and  year  of  birth. 

(g)  Specify  city,  town,  or  other  locality  of  birth,  whatever  the  nationality. 

(//)  Enter  (from  recruit's  statement)  all  former  diseases  and  injuries. 

(i)  Give  former  occupation  or  occupations. 

(j)  For  enlisted  persons  give  the  number  of  continuous-service  certificate  and 
years  of  previous  service. 

(k)  Give  name  and  address  of  nearest  relative  or  friend. 

(/)  Enter  religion. 

(m)  Eyes:  Blue,  gray,  blue-gray,  yellow-gray,  hazel  (light  brown),  dark  brown, 
bicolored  (as  when  the  pupillary  border  is  of  a  different  color  from  rest  of  iris); 
tat i-  when  the  two  eyes  are  of  different  colors. 

(n)  Hair:  Flaxen,  sandy  (yellowish  red),  auburn  (reddish  brown),  brown  (light, 
dark,  or  very  dark),  black;  also  whether  thin,  bald,  straight,  curly,  or  woolly. 

(0)  Complexion  is  not  to  be  described  as  simply  "light"  or  "dark,"  but  the 
character  and  degree  shall  be  as  accurately  stated  as  possible;  as  complexion,  pallid, 
sallow,  fair  (only  when  decidedly  clear),  ruddy,  florid,  dark  (tawny,  sunburnt,  or 
tanned),  very  dark  (swarthy  or  dusky),  mulatto/ negro. 

(p)  Height  to  be  expressed  in  inches;  the  body  to  be  erect,  the  chin  neither  ele- 
vated nor  depressed,  the  feet  and  knees  touching,  legs  stiff,  and  arms  hanging  per- 
pendicularly. 

(q)  Weight,  body  nude,  or  allowance  made  for  clothing  worn.  Accuracy  of 
scales  to  IK-  ascertained  before  using. 

(r)  Vision  to  be  expressed  a<  a  fraction,  of  which  the  numerator  will  be  the 
distance  at  which  Snellen's  2o-foot  test  can  be  determined,  and  the  denominator  20. 

(s)  Hearing  is  to  1.  I  fraction,  of  which  the  numerator  will  be  the 

distance  in  feet  a  whispered  voice  can  be  heard,  and  the  denominator  15. 

(/)  Circumference  of  thorax  to  express  the  mean  of  the  greatest  circumference 
a:'ter  forced  inspiration  and  of  the  least  after  forced  expiration,  measured  by  a  tape- 
line  horizontally  at  the  precise  level  of  the  nipples;  the  difference  between  the  greatest 
and  least  circumference  to  be  entered  as  expansion. 

(tt)  Teeth  missing  or  useless  shall  be  indicated  by  marking  the  dental  formula 
as  noted. 

(v)  Remarks:  Note  any  prominent  physical  trait  not  inconsistent  with  bodily 
vigor  or  not  in  such  degree  as  to  constitute  cause  for  rejection — leanness  or  the 


460  NAVAL   HYGIENE 

reverse;  hirsuteness;  slight  asymmetry  of  body  or  limbs,  knock-knees,  bow-legs,  or 
flat  feet;  peculiarities  of  teeth  and  genitalia;  slight  varicocele,  etc.  In  this  connection 
examiners  are  to  remember  that  imperfections  that  might  pass  in  a  man  should  reject 
boys. 

(TV)  Marks  and  scars  should  be  indicated  as  required  on  the  printed  outline 
figure. 

(x)  Enter  the  date  and  nature  of  any  waiver  requested. 

(y)  Finally  sign  the  record  in  the  space  provided.  Corrections  made  subsequent 
to  enlistment  to  be  entered  in  red  ink  and  initialed. 

2242.  This  record  shall  be  prepared  for  each  officer  and  enlisted  man  of  the  Navy 
and  Marine  Corps  and  for  members  of  the  Nurse  Corps. 

Identification  Records  and  Finger  Prints 

Identification  records,  consisting  of  finger  prints  and  personal  descriptions,  will 
not  hereafter  be  forwarded  to  the  Bureau  of  Navigation  upon  the  reenlistment  of 
men  if  the  date  of  last  enlistment  was  subsequent  to  January  i,  1907,  or  upon  dis- 
charge for  undesirability,  bad  conduct,  or  with  dishonorable  discharge  if  enlisted 
subsequent  to  that  date. 

The  files  of  finger  prints,  which  were  inaugurated  January  i,  1907,  are  now  prac- 
tically complete  for  the  term  of  enlistment  provided  by  law,  and  in  future  it  will 
only  be  necessary  to  forward  finger  prints  and  personal  descriptions  in  the  following 
cases : 

On  first  enlistment. 

On  reenlistment  from  the  Army  or  Marine  Corps. 

On  reenlistment  when  date  of  last  enlistment  was  prior  to  January  i,  1907. 

Upon  discharge  as  undesirable  or  with  bad  conduct  or  dishonorable  discharge  if 
the  enlistment  occurred  prior  to  January  i,  1907. 

In  future  it  will  only  be  necessary  to  forward  identification  records  in  the  follow- 
ing cases  to  headquarters,  United  States  Marine  Corps: 

Upon  application  for  first  enlistment. 

Upon  reenlistment  from  Army  or  Navy. 

Upon  reenlistment  from  the  Marine  Corps  when  date  of  last  enlistment  was  prior 
to  January  i,  1908. 

Upon  discharge  as  undesirable  or  with  bad  conduct  or  dishonorable  discharge  if 
the  enlistment  occurred  prior  to  January  i,  1908. 

Identification  records  will  not  hereafter  be  forwarded  upon  the  reenlistment  of 
men  if  the  date  of  last  enlistment  was  subsequent  to  January  i,  1908. 

Outline  Figure  Card  and  Descriptive  List 

[From  Chap.  12,  Manual  for  the  Medical  Department] 

2101.  The  outline  figure  on  the  reverse  side  of  the  finger-print  record  shall  be 
filled  out  in  the  case  of  every  recruit  that  has  been  found  physically  qualified  and 
accepted  for  enlistment  and  for  every  sailor  or  marine  who  presents  himself  for  reen- 
listment when  date  of  last  enlistment  was  prior  to  January  i,  1907. 


APPENDIX 


461 


2102.  Medical  officers  on  recruiting  duty  shall  observe  the  greatest  care  in  the 
preparation  of  these  cards  and  shall  exercise  every  care  that  the  record  on  each  card 
n  ay  be  complete. 

2103.  The  medical  officer  shall  make  a  careful  and  systematic  examination  of  the 
body  of  the  man,  front  and  rear,  on  each  side  of  the  median  line,  separately,  commen- 
cing at  the  scalp  and  ending  at  the  foot,  and  the  following  directions  shall  be  carefully 
noted: 


143. — Outline  figure  card  upon  which  deformities,   injuries,   scars,   moles 
and  marks  may  be  indicated  and  described. 

(a)  Cards  showing  less  than  five  marks  in  addition  to  vaccination  scars,  tattooing, 
oss  of  teeth,  and  deformities  (which  should  likewise  be  noted)  cannot  be  relied  upon 
t  the  effort  to  dUrovi-r  identity  or  to  identify  a  person  in  suspected  cases.  Experience 

>\vs  that  as  many  as  10  or  15  marks  may  usually  be  found. 

(6)  If  no  marks  be  found  upon  the  recruit,  the  fact  should  IK-  stated  upon  both 
the  front  and  back  of  the  card.  If  marks  are  found  upon  the  front  and  none  upon 


462  NAVAL  HYGIENE 

the  rear,  or  vice  versa,  the  entry  "no  mark"  should  be  made  upon  the  appropriate 
side  of  the  card. 

(c)  Outline  figure  cards  are  to  be  made  out  in  permanent  black  ink.     Copying 
ink  or  indelible  pencils  should  not  be  used. 

(d)  Name. — Christian  and  middle  name  in  full  and  surname  in  the  order  to  be 
used.     The  name  should  be  written   very  plainly,  or  preferably   typewritten   or 
printed  in  plain  gothic  letters. 

(e)  Rate. — The  rate  in  which  recruit  is  enlisted  shall  always  be  stated. 

(/)  Age. — The  age  at  the  time  the  card  is  prepared  is  the  one  that  shall  be  given. 

(g)  Height. — The  height  is  to  be  given  in  inches,  and  as  it  is  relied  upon  as  a  base 
in  comparing  the  cards  of  recruits  with  the  classified  descriptions  of  the  former 
sailors  or  marines,  and  as  the  measurement  may  to  a  considerable  degree  be  affected 
by  efforts  at  deception  on  the  part  of  the  recruit,  great  care  in  ascertaining  it  is 
enjoined. 

(h)  Hair. — The  scale  of  hair  colors  may  be  given  as  follows:  Flax  color;  light 
brown;  of  red  hair,  as  follows:  brick  red,  sandy  red,  auburn  (reddish  brown);  dark 
brown;  black;  of  gray  hair,  as  follows:  dark  gray,  light  gray  (approaching  white), 
iron  gray  (mixed). 

(i)  Eyes. — The  eyes  should  be  compared  by  placing  the  subject  with  the  face  in 
good  light.  Slide  the  Standard  Eye  Chart  up  or  down  the  left  side  of  the  face,  close 
jto  the  left  eye.  The  nearest  approach  in  similarity  of  color  is  the  number  to  be 
given.  If  the  right  eye  is  distinctly  different  in  color,  its  number  also  should  be  given. 

(j)  White  or  Colored. — Write  the  word  "white"  or  "colored"  to  indicate  race 
as  the  case  requires.  Do  not  indicate  by  crossing  out  one  of  the  words. 

(k)  Date  of  Last  Prior  Enlistment  in  the  Navy  or  Marine  Corps. — If  the  recruit 
has  had  no  prior  service  in  the  Navy  or  Marine  Corps,  write  the  word  "none." 

(/)  Missing  Teeth. — To  indicate  the  missing  or  useless  teeth,  mark  with  an  X  the 
letters  corresponding  to  the  teeth  that  are  absent  or  useless.  Teeth  that  are  partly 
decayed  should  be  indicated  by  drawing  a  diagonal  line  through  the  corresponding 
letters.  If  none  are  missing,  write  the  word  "no"  in  front  or  above  the  words  "miss- 
ing teeth."  This  will  show  that  they  were  not  overlooked. 

(m)  Station  and  Date. — Write  the  name  of  the  station  at  which  the  card  is  made 
out  and  the  date  of  its  preparation. 

2104.  Marks  on  the  outline  figure  card  should  be  made  at  points  corresponding  to 
those  occupied  by  the  marks  on  the  body  of  the  recruit.  This  may  readily  be  accom- 
plished by  drawing  imaginary  lines  on  the  body  of  the  recruit  like  the  dotted  lines  on 
the  card  and  placing  the  mark  in  the  proper  position  on  the  card.  As  the  dotted 
lines  mark  the  boundaries  of  regions  which  are  used  in  the  systematic  arrangement 
of  the  cards  for  purposes  of  identification,  it  is  important  that  each  mark  on  the 
card  should  be  placed  in  its  proper  position. 

(a)  A  pen  picture  is  desired  of  all  marks,  showing  their  inclination  and  general 
shape.     In  the  case  of  tattoos,  this  is  optional. 

(b)  A  straight  line  should  be  drawn  from  each  mark  to  its  description  on  the 
right  or  left  of  the  figure.     When  avoidable,  these  lines  should  not  cross  each  other. 

(c)  When  a  description  is  common  to  a  number  of  marks,  it  need  not  be  repeated 
for  each  one,  but  the  lines  may  converge  to  it,  if  they  can  do  so  without  crossing 
others. 


APPENDIX 

•       \~r 

(d)  The  sizes  of  all  scars,  moles,  warts,  birthmarks,  etc.,  are  to  be  given  in  inches 
or  fractional  parts  thereof,  except  in  the  case  of  pinhead  moles  (abbreviation  p.  m.). 

(e)  I'inhcad  moles  are  moles  less  than  one-eighth  of  an  inch  in  diameter. 

(/)  Tattoo  marks  should  invariably  be  noted  and  described  in  detail  as  they 
appcir.  In  the  case  of  devices  composed  of  two  or  more  figures,  the  component 
parts  should  be  named,  e.g.,  "heart,  cross,  and  anchor,"  not  "faith,  hope,  and 
charity;"  "clasped  hands,"  not  "friendship;"  "eagle,  shield,  crossed  cannon,  flags, 
and  arrows,"  not  "American  coat  of  arms."  The  same  applies  to  all  emblems,  coats 
of  arms,  lodge  pins,  badges,  etc. 

(g)  Letters,  initials,  and  words  should  be  printed,  by  hand,  in  plain  roman  capitals 
or  ijothk,  thus;  "  J.  M.  H.,"  "U.  S.  V.,"  "I.  X.  L,"  "IN  GOD  WE  TRUST,"  etc. 

(/;)  Details  of  costume,  posture,  and  relationship  to  other  devices  should  be 
given  in  the  case  of  tattooed  representations  of  men  and  women,  e.g.",  woman 
clirging  to  a  cross;"  "man  and  woman  embracing,  houses,  lighthouse,  and  ship  in 
the  background;"  "sailor  standing  by  a  tombstone,  weeping  willow  overhead,  cap 
in  right  hand,  words  'in  memory  of  my  mother'  on  stone." 

The  size  of  tattoos  need  be  given  only  in  the  case  of  dots,  blotches,  circles, 
liru  -,  etc. 

(j)  It  is  not  necessary  to  state  the  color  or  kind  of  pigment  used  in  the  tattooing. 

(k)  Do  not  crowd  the  description  of  tattoos  between  the  right  arm  of  the  figure 
ami  the  edge  of  the  card  in  front,  nor  the  left  arm  and  edge  of  the  card  on  the  back. 

(/)  Indecent  or  obscene  tattooing  is  cause  for  rejection,  but  the  applicant  should 
he  given  an  opportunity  to  alter  the  design,  in  which  event  he  may,  if  otherwise 
qu;  lified,  be  accepted. 

I  )o  not  write  on  the  figure.     The  figure  is  to  be  used  only  for  the  purpose  of 
locating,  by  pen  pictures,  the  different  marks  found  on  the  body  of  the  recruit. 

(n)  Amputations  and  losses  of  parts  of  fingers  and  toes  should  be  noted,  showing 
the  particular  member  injured  and  how  much  of  it  is  gone. 

2105.  The  following  abbreviations  are  authorized  and  will  be  understood  in  the 
sen>c  indicated,  vi/.:  Amp.,  amputation;  bl.,  blue;  bmk.,  birthmark;  bro.,  brown;  d., 
de|  rcssed  'except  when  following  a  dimension;  then  it  stands  for  diameter);  f., 
flat:  fl..  tle-hy;  h.,  hairy;  m.,  mole;  p.,  pitted;  p.  m.  pinhead  mole;  r.,  raised;  s.,  scar 
or  Miiooth;  v.,  vaccination;  var.,  varicose  veins  or  varicocele;  w.,  wart. 

All  rombinatiims   <>f    the>e    abbreviations  are  admissible,  e.g.,  p.  s.  %  d., 
pitted  -car  '  •>  inch  in  dianu-ter  :   i  inch  long;  f.  p.  s.  i  x  %,  an  oval,  flat, 

pitted  scar,  i  inch  long  and   { -2  inch  wide. 

(6)  Abbreviations  denoting  >hape  are  unnecessary,  for  the  letter  "d"  following 
a  dimension  >ho\vs  that  the  mark  is  circular.  Two  dimension-  given  indicate  that 
the  mark  is  oval  or  oblong,  and  when  no  letter  follows  the  dimension  it  is  understood 
that  the  mark  or  scar  i>  linear. 

(f)  When  a  linear  mark  or  scar  i>  otherwise  than  >traight  the  length  to  be  given 
i-  thr  -horte>t  distance  from  one  extreme  to  the  other. 

(</)  The  letters  "T.  M."  should  not  be  used  as  abbreviations  for  "Tattoo  marks," 
a>  they  are  liable  to  be  taken  for  tattooed  letters  on  the  person. 


464  NAVAL  HYGIENE 

Finger  Prints 

The  apparatus  for  taking  finger  prints  consists  of  a  form  holder,  an  ink  plate,  and 
a  roller  for  spreading  the  ink  on  the  plate. 

Keep  the  roller  and  ink  plate  clean  and  free  from  dust,  grit,  or  hairs,  and  the  ink 
tube  closed  when  not  in  use.  When  the  day's  work  is  finished,  clean  the  ink  from  the 
plate  and  roller  by  means  of  a  cloth  and  benzene.  When  not  using  the  roller, 
rub  it  with  a  little  sweet  oil  or  lubricating  oil  before  laying  it  away,  to  prevent  the 
composition  from  becoming  too  hard. 

Preparatory  to  taking  finger  prints  squeeze  a  small  quantity  of  ink  from  the  tube 
and  carefully  work  it,  by  use  of  the  roller,  into  a  thin  film  on  the  plate,  the  spreading 
of  which  may  be  facilitated  by  frequently  turning  over  the  roller.  //  too  much  ink 
is  used,  the  impression  will  be  blurred  and  consequently  unsatisfactory.  The  thickness 
of  the  ink  after  being  spread  on  the  plate  should  be  less  than  one-half  the  elevation 
of  the  ridges,  and  this  can  be  tested  by  taking  impressions. 

The  recruit  should  wash  his  hands  thoroughly  with  soap  and  brush,  using,  if 
practicable,  running  water,  especial  care  then  being  taken  to  rinse  off  all  soap  or 
lather  with  cold  water.  Failure  to  do  this  will  cause  white  blotches  to  ap- 
pear in  the  impressions.  Immediately  before  placing  the  fingers  on  the  inked  plate 
the  fingers  should  be  well  wiped  with  a  cloth  dampened  with  benzene  or  ether,  which 
should  remove  all  trace  of  grease,  water,  or  perspiration. 

Two  kinds  of  impressions  are  used,  "plain"  and  "rolled."  A  plain  impression 
is  obtained  by  pressing  the  bulb  of  the  finger,  with  the  plane  of  the  nail  parallel  to 
the  plane  of  the  plate,  on  the  inked  plate  and  then  on  the  paper  in  the  same  manner. 
A  rolled  impression  is  obtained  by  placing  the  side  of  the  finger  on  the  inked  plate, 
with  the  plane  of  the  nail  at  right  angles  to  the  plane  of  the  plate,  and  rolling  the 
finger  over  from  one  side  to  the  other  until  the  plane  of  the  nail  is  again  at  right 
angles  to  the  plane  of  the  plate,  but  with  the  bulb  surface  of  the  finger  facing  in  the 
opposite  direction,  thus  inking  the  surface  of  the  finger,  and  then  rolling  the  finger  over 
the  paper  in  the  same  manner,  in  this  way  obtaining  a  clear  impression  of  the 
ridges  on  the  surface  of  the  finger.  This  latter  impression  should  include  both  the 
palmar  surface  and  the  sides  of  the  finger  between  the  tip  and  the  flexure  of  the  last 
joint.  Always  roll  the  fingers  from  the  awkward  position  to  the  natural  position. 

It  is  absolutely  necessary  that  the  finger  prints  shall  be  clear,  that  the  ridges  shall 
be  distinctly  outlined,  and  that  the  "rolled"  impressions  shall  be  sufficiently  large 
to  include  all  the  points  needed  for  accurate  classification,  and  free  from  blur.  Black 
impressions  are  better  than  light  ones  if  the  spaces  between  the  ridges  are  free  from 
blur. 

When  the  skin  of  the  fingers  is  in  poor  condition,  make  special  effort  to  get  best 
results. 

Entire  palmar  surface  of  first  joint  should  be  inked  so  that  whole  contour  of 
pattern  will  be  shown  when  finger  is  rolled. 

Recruit  should  first  be  required  to  sign  his  name,  and  then  to  roll  the  impression 
of  the  right  index- finger  in  the  space  above  his  signature.  This  will  eliminate  e  ntirely 
the  possibility  of  the  recruit  signing  other  than  his  own  identification  record.  Have 
only  one  recruit  at  a  time  present  in  the  room  where  prints  are  being  made,  and  com- 


APPENDIX  465 

plete  and  file  each  record  before  the  next  man  enters  or  is  taken  up.  In  this  way  no 
other  record  than  the  one  in  question  is  available  or  within  reach  of  the  recruit 
being  recorded,  therefore  he  can  sign  no  record  but  his  own.  Do  not  allow  records 
to  lie  around,  but  file  or  otherwise  dispose  of  them  at  once  after  completing  examina- 
tion. 

In  taking  impressions,  the  operator  himself  should  manipulate  the  hands  of  the 
recruit,  who  should  be  directed  to  relax  his  fingers  and  not  to  attempt  to  assist  by 
ad' ling  to  the  pressure  on  the  inked  plate  or  on  the  paper.  In  order  that  the  ink 
m;iy  be  taken  up  on  the  finger  evenly  and  in  sufficient  quantity,  an  unused  part 
of  the  plate  should  be  selected  each  time  for  inking  the  finger,  and  when  no  unused 
part  of  the  plate  remains  the  ink  should  be  redistributed  with  the  roller  or  the  plate 
re-inked.  See  that  there  are  no  clots  of  ink  where  the  fingers  are  to  be  rolled  on  the 
plate. 

The  form  holder,  which  is  intended  to  prevent  the  form  from  moving  about  and 
bk  rring  the  print  while  impressions  are  being  taken,  will  be  used.  The  best  results 
will  be  obtained  with  a  table  that  places  the  form  holder  at  about  the  height  of  the 
elbow  of  the  recruit  when  he  is  standing  with  his  arms  hanging  at  his  sides. 
To  place  a  form  in  the  holder,  press  out  the  plate  by  means  of  the  levers  at 
the  ends,  place  the  form  in  position  under  the  plate,  and  push  back  the  levers  to 
their  original  position.  The  pressure  of  the  springs  on  the  plate  will  hold  the  form 
firmly  in  position. 

To  record  the  finger  prints  on  Bureau  of  Navigation  Form  No.  2  and  United 
Sta.tes  Marine  Corps  Form  N.  M.  C.  330,  place  one  of  the  blank  forms  in  the  holder, 
with  the  upper  heavy  black  line  appearing  just  above  the  upper  edge  of  the 
plate;  then  take  the  rolled  impressions,  in  the  order  named  and  in  proper  spaces 
on  the  form,  of  the  thumb,  index,  middle,  ring,  and  little  fingers  of  the  right 
hand,  the  impressions  to  be  located  on  the  form  so  that  the  flexure  of  the  last 
joint  is  immediately  above  the  folding  line.  This  will  leave  room  for  a  second  print 
to  be  taken  in  the  upper  part  of  the  space  in  case  the  first  print  is  defective. 

After  the  impressions  of  the  fingers  of  the  right  hand  have  been  taken,  move  the 
foni  in  the  holder  until  the  lower  heavy  black  line  appears  just  above  the  edge  of 
the  plate;  then  take  the  rolled  impressions  of  the  fingers  of  the  left  hand  in  the  proper 
spa*  es  on  the  form. 

After  the  rolled  impression  of  each  finger  of  both  hands  has  been  obtained,  again 
move  up  the  form  in  the  holder  until  the  plate  covers  only  enough  of  the  lower  edge 
of  the  form  (not  exceeding  'i  inrhi  to  hold  it  in  place.  Then  take  a  plain 
impression  of  the  four  fingers  of  the  right  hand  at  one  time,  the  fingers  being  held 
together  so  as  to  bring  the  prints  within  the  allotted  space,  and  a  similar  plain  impres- 
sion of  the  lingers  of  the  left  hand.  Below  the  finger  impressions  take  a  plain 
impression  of  each  thumb. 

The  method  of  obtaining  the  plain  impressions  is  to  take  each  of  the  fingers  in 
turn  and  place  the  bulbs  only  on  the  inked  plate.  When  this  is  done,  press  the  re- 
cruit's lingers  together,  and  with  his  hand  limp  and  Hat  (not  bowed  or  arched)  place 
it  in  the  space  shown  on  the  form  and  pre»>  each  finger  at  the  base  of  the  nail, 
lightly.  No  attention  need  be  paid  to  the  deltas  in  the  plain  simultaneous  impres- 

30 


466 


NAVAL  HYGIENE 


sions,  but  the  detail  must  be  clearly  defined.     These  impressions  are  used  to  deter- 
mine if  the  rolled  impressions  are  in  their  proper  sequence. 

A  finger  should  not  be  noted  missing  if  any  portion  of  it  beyond  the  flexure  of 
the  terminal  joint  remains.  The  end  of  a  mutilated  finger  should,  in  all  cases,  be 
inked  and  recorded  as  in  the  case  of  a  perfect  digit. 


DO  NOT  FOLD  THIS  FORM. 


Classification,  No.  — 

RIQHT    HAND. 


LEFT    HAND. 


l_EF"T    HAND. 

Plain  impression  of  the  four  finders  tiiken  ; 


RIGHT     HAND. 

.;,  ..f  fin-  ;..ur  fliitf.'r.-  tak.'i 


FIG.   144. — Properly  made  finger  prints. 

No  amount  of  pressure  by  the  operator  should  be  used  in  making  or  inking  rolled 
impressions.  It  is  the  pressure  that  causes  the  ink  to  more  readily  run  in  between 
the  ridges.  The  finger  tips  should  be  allowed  to  touch  the  paper  only  with  sufficient 
pressure  to  make  a  record. 

The  utmost  care  should  be  taken  in  recording  the  impressions  of  the  little  lingers. 
From  these  fingers  a  subclassification  number  is  obtained. 


APPENDIX 


467 


When  the  finger-print  side  of  the  form  has  been  completed,  the  impressions  will 
be  inspec  ted  to  make  sure  that  they  are  dear  and  free  from  blur;  that  all  delta-  are 


FK,.    145. — Deltas. 


FIG.   146. — Cores  of  loops. 


Fu..   147. — An  arch. 


IMI..    i  .js.      A  •  rated  arch. 

shown  in  the  rolled  impressions,  and  that  the  whole  contour  of  the  pattern  is  shown. 
T  K-  rolled  impressions  will  alx>  be  compared   with  the  plain  impressions  for  the 


468 


NAVAL  HYGIENE 


purpose  of  ascertaining  whether  they  are  recorded  in  proper  sequence.  Any  defect- 
ive impressions  will  then  be  remedied  by  taking  another  print  in  the  upper  part  of 
the  proper  space  or  by  using  a  new  form,  if  necessary.  If  the  impressions  are  not 
recorded  in  proper  sequence,  a  new  form  must  be  used,  the  old  one  being  destroyed. 


FIG.  149. — Radial  loop,  right  hand,  or  ulnar  loop,  left  hand. 

After  the  finger  prints  have  been  taken  and  examined,  the  opposite  side  of  the 
form  will  be  filled  out  and  the  personal  description  completed  by  noting  on  the 
outline  figures  the  principal  identification  marks. 


FIG.   150. — Ulnar  loop,  right  hand,  or  radial  loop,  left  hand. 

Before  making  the  entries  on  the  personal  description  side  of  the  blank,  allow 
the  ink  on  the  finger-print  side  to  become  sufficiently  dry  to  prevent  blurring  by 
rubbing.  A  few  minutes  will  be  sufficient  if  the  form  is  handled  carefully  and  not 
rubbed  about  on  the  desk  while  the  personal  description  is  being  entered.  A  sheet 


APPENDIX 


469 


of  blotting  paper  placed  under  the  form  will  protect  it  to  some  extent.  If  an 
impression  becomes  blurred  at  any  time,  a  new  impression  must  be  taken  in  the  upper 
part  of  the  proper  space,  or,  if  necessary,  the  imperfect  form  should  be  destroyed  and 
a  new  blank  used. 


FIG.   151. — A  whorl  showing  two  deltas. 

delta  may  be  formed  by  the  bifurcation  of  a  single  ridge  or  by  the  abrupt 
ivcrgence  of  two  ridges  that  hitherto  had  run  side  by  side  (see  Fig.  145). 

The  core  of  a  loop  may  consist  either  of  an  even  or  uneven  number  of  ridges 
not  joined  together  (set    Fiur.  146). 


\ 


I" i'.     152. —  Composite,  showing  two  deltas. 


Art  In  r.     In  an  lies  the  ridges  run  from  one  side  to  the  other,  making  no  backward 
turn.     Arches  have  no  deltas  (Fig.  147). 

!  rches. — In  patterns  «>f  the  arch  type  the  ridges  near  the  middle  may  have 
an  upward  thrust,  arranging  themselves,  as  it  were,  on  both  sides  of  a  spine  or  axis, 


470 


NAVAL   HYGIENE 


toward  which  adjoining  ridges  converge.  The  ridges  thus  converging  give  to  the 
pattern  the  appearance  of  a  tent  in  outline,  hence  the  name  tented  arch.  Tented 
arches  have  no  deltas  (Fig.  148). 

In  loops  some  of  the  ridges  make  a  backward  turn  but  without  twist;  there  is  one 
delta.  If  the  downward  slope  of  the  ridges  about  the  core  is  from  the  direction  of 
the  little  ringer  toward  that  of  the  thumb  it  is  a  radial  loop.  Figure  149  is  a  radial 
loop  in  the  right  hand.  The  heavy  black  line  drawn  from  the  delta  to  the  core  indi- 


FIG.   153. — Ulnar  loop  (right  hand)  showing  65  points  of  identification. 

cates  the  ridges  that  are  counted  in  classifying  loops.  In  this  impression  the  line 
cuts  or  crosses  16  ridges.  If  the  downward  slope  of  the  ridges  about  the  core  is 
from  the  thumb  side  toward  the  little  finger  the  loop  is  ulnar.  Figure  150  is  an  ulnar 
loop  in  the  right  hand  or  a  radial  loop  in  the  left  hand.  In  this  impression  the 
heavy  black  line  crosses  10  ridges.  Be  sure  that  the  delta  is  shown  if  the  impression 
is  a  loop. 

Whorls. — In  whorls  some  of  the  ridges  make  a  turn  through  at  least  one  com- 


\iMM.\m\ 


47' 


plctc   circuit.     There   arc   two   delta-.      Whorls   arc   single   corc<l    or  double  cored 
The  right  and  left  delta-  in  thi-  impression  arc  shown  hythc  arrowhead-. 
The  deltas  in  whorls  must  alwuy>  he  shown,  in  order  that  the  tracings  may  he  prop- 
erly made.      In  whorls  the  ridge  traced  starts  from  the  left  delta  and  is  traced  toward 
the  right  delta.     \Yhen  the  ridge  whose  course  is  traced  meets  the  corresponding 
right  delta  ridge  the  whorl  is  spcciali/ed  as  M;  when  this  ridge  goes  inside  of  the 
right  delta  with  three  or  more  ridges  intervening  it  is  specialized  as  I;  when  the 
ridge  traced  goes  outside  of  the  right  delta  with  three  or  more  ridges  intervening  it 
•vialized  as  O. 

are  152  is  a  composite.  This  pattern  is  classed  as  a  whorl  and  has  two  deltas. 
The  right  and  left  deltas  in  this  impression  are  shown  by  the  arrowheads. 

Figure   153  shows   ridge  characteristics  used  in  establishing  the  identity  of  a 

l'nle-s  an  impression  is  free  from  blur  great  difficulty  is  encountered  in 

picking  out  the  points  of  comparison  between  two  impressions.     Sixty-five  points  of 

omparison  are  shown  on  this  impression  which  are  free  from  blur  and  could  all  be 

if  purposes  of  comparison  and  identification  with  another  print  of  the  same 

individual. 

:i  operator  should  instruct  his  relief  in  the  taking  of  finger  prints,  so  that  the 
Bureau  of  .Navigation  and  Marine  Headquarters  will  be  able  to  receive  good 
"ingcr-print  impressions  at  all  time-;. 

The  -kin  on  the  finger  tip>  of  the  bodies  of  men  which  have  been  recovered  from 

:  he  water  will  be  greatly  wrinkled  or  shriveled,  so  that  without  some  treatment  the 

nrikiri.-  actory  prints  may  be  difficult  and  even  impossible.     The  way  to 

MIC  this  is  to  inject  water  with  a  hypodermic  syringe  beneath  the  skin  of  the 

bulb  of  the  linger.     This  will  smooth  out  the  skin  for  the  impression.  . 


INDEX 


Abdomen,  263,  454 
Al»inthe,  355 
Absolute  moisture,  23 
Acanthia  lectularia,  324 
Acarus  scabei,  323 
Accidents  to  submarines,  283 
Acetic  acid  for  lice,  324 
Acids,  fruit,  131 

nucleic,  131 
Admission  rate,  calculated,  440 

engine-room  force,  196 

fire-room  force,  198 

tuberculosis  in  United  States  Navy, 
403 

venereal  diseases  in  United  States 

Navy,  380 

Adulterations  of  milk,  141 
Aerial    navigation,  oxygen   inhalations, 
16,  267,  274 

see  Aviation 
Aerobioscope,  45 
Ae>ti\  o-autiimnal  malaria,  405 
After  images,  123 

•i/.  Alexander,  360 
Agramuntf,  Ari>ti<les,  418 
Air,  i') 

analysis,  43 


Air, 


43, 

chemical,  43 

physical,  43 
aqueous  vapor 
bacteriology,  36 
carbon  dioxide,  23,  43 
carbon  monoxide,  44 
chemical  composition,  ji 
chlorine,  279 
components  of,  22 


compressed,  279,  287 

currents,  19 

definition,  21 

density,  19 

determination  of  quantity,  required, 

63 

diving,  287 
elasticity,  19 
essential  components,  22 
exchange,  38,  46 
fumes  from  fuel  oil,  279 
humidity,  21 
hydrogen,  278 
inorganic  matter,  35 
man's  requirements, 
cubic  air  space  per  man,  46 
afloat,  48 
barracks,  47 
hammocks,  49 
navies,  48 

officers'  staterooms,  49 
mobility,  19 
nitrogen,  23 

non-essential  constituents,  argon,  29 
coronium,  29 
helium,  29 
krypton,  29 
neon,  29 
ozone,  29 

peroxide  of  hydrogen,  29 
xenon,  29 
on  shipboard,  37 

per  capita  air  space,  48 

in  British  Navy,  49 
pollution,  37 
organic  matter,  35 
oxygen,  22 


473 


474 


INDEX 


Air,  particulate  matter,  35,  41 

physical  characteristics,  16 

physiology,  effect  on,  19 

poisonous  gases,  30,  357 

pollutions,  29 
aboard  ship,  37 
on  submarines,  278 

pressure,  266,  271 

relative  humidity,  24 

sea,  22 

sulphuric  acid  fumes,  278 

temperature,  16 

weight,  19 

see  Heating. 

see  Ventilation. 
Air  ports,  54 
Air  sickness,  270 
Air  washers,  62 
Albatross,  U.  S.  S.,  156 
Albumen  in  heat  cramps,  368 
Alcohol,  153 

addicts,  338 

contained  in  cocoanuts,  354 

contained  in  soft-drink  bottles,  354 
Alcoholic  beverages,  353 

custody  of,  354 

inspection  of  bottles  containing,  354 
Alcoholic  drink,  venereal  disease,  382 
Alexander,  A.  B.,  316 
Alg«,  86 

Altitude,  highest  inhabited,  16 
Alum,  109,  114 

in  Darnall  siphon  filter,  118 
American  Public  Health  Association,  95 
Ammonia,  30,  32 

albuminoid,  92,  100 

-free  water,  98 

estimation  of,  98,  100 

-free  ammonia,  92,  98 

solutions  necessary  to  estimate,  98, 

100 

Ammunition  hoists,  55 
Anaesthetizing  room,  hospital  ship,  332 
Ancylostoma  duodenale,  413 
Ancylostomiasis,  412 

cause  of,  412 

life  history,  414 


Ancylostomiasis,     prevalence    in      the 
Navy,  414 

prophylaxis,  414 
Anderson,  J.  F.,  394 
Animal  kingdom,  clothing  from,  168 

fur,  169 

leather,  169 

silk,  1 68  . 

wool,  1 68 
Animal  matter,  decomposing  in  water, 

92 

Animal  parasites  in  water,  108 
Ankylosis,  258,  262 
Anophelinae,  406 
Anthrax,  142 

spores,  42 
Anthropotoxin,  32 
Anti- mosquito  measures,  418 
Anti-spitting  laws,  375 
Anti-typhoid  inoculation,  409,  411 
•    site  of  injection,  411 

statistics  in  U.  S.  Navy,  410 

triple  vaccine,  411 
Apparatus,  diving,  285 
Apparently  drowned,  see  resuscitation 

of,  303 

Appendicitis,  351 
Aqueous  vapor,  22,  23,  37,  38 

sources  of,  28 

Architecture,  naval  (see  Naval  Architec- 
ture), 7 

Arctic  overshoe,  187 
Argon,  29 

Arkansas,  U.  S.  S.,  73,  218 
Arloing,  121 
Arms,  262 
Army  uniform,  172 
Aron,  127 
Arrowroot,  151 
Arsenic  poisoning,  35 
Artesian  water,  83,  85 

wells,  91 

Artificial  ventilation,  see  Ventilation. 
Asaprol,  426 
Aseptol,  426 
Ash,  148,  149,  150 
Ashburn,  P.  M.,  419 


INDEX 


475 


Ashes,  in  air,  41 

Aspiration,  50,  51 

Athletics,  349 

Atmospheric  pn  .,  291 

Atropine,  in  heat  cramp-.  373 

in  seasickness,  361 
Atwater,  134,  135,  137 
Average  strength  of  U.  S.  Navy,  how 

computed,  438 
Avery,  401,  402 
Aviator's  clothing,  189 

brogans,  191 

goggles,  190 

helmet,  189 

leather  suit,  190 

mask,  190 

waders.  KM 

Aviator'-  da/./ling,  272 
Aviation, 

duty  of  in-tructor-,  27  i 

launching  hydroplanes.  275 
•  •n  tension,  269 

physical  requirements  for. 
Aviators,  requirement;*  for,  2<><> 

examination  for,  267 
Awnings,  on  small  boat-.  ji<> 

Bacillary  di>ea-e-.  -putum-borne,  376 

Bacillary  dy-entery,  376 

Bacillus  aerogenes  capsulatus,  144 

anthracis,  i  2  i 

botulinu-. 

coli.  .  ioS 

diphtheria 

dy-.i-nlrri.-r.  414 


Boon 

indiais,  96 

lactis  aer« 

lactis  anaerogenes,  96 

leprar,  tarried  by  li«  < 

carried  by  bi-«|  bugs.  325 
megatherium,  (><> 

mycoidt  - 

paratypho-us,  A.  410 
|l8,4IO 

rtussis,  39<>,  39' 


Bacillus  pestis,  419 

prodigiosus,  36,  42 

pyocyaneus,  42 

subtilis,  96 

tuberculosis,  403 

typhi  exanthematici,  422 

typhosus,  42,  91,  93,  96,  118,  409, 

410,  414 
in  well  water,  91 

violaceus,  96 
Bacteria  in  air  at  sea,  36 

in  water,  86 

not  spread  by  dust,  42 

on  ship  board,  42 

permissible  limit  in  water,  108 

spread  by  dust,  42 
Bacterial  diseases  transmitted  by  flies, 

328 

Bacteriological  examination  of  air,  45 
B:K  teriological   laboratory   on   hospital 

ship,  332 
liacteriology,  diphtheria,  384 

ivrrbro-spinal  fever,  392 

chickcnpox,  399 

cholera,  417 

<l\-entery,  414 

Malta  fever,  422 

milk,  142 

plague,  419 

pneumonia,  401 

scarlet  fever,  396 

tuberculosis,  403 

typhoid  fever,  400 

typhus  fevrr,  422 
Bags,  canvas,  for  clothing,  173 
Bakery,  202 

re  of,  203 

personnel  of,  204 
Balloon,  captivt 
Baltimore,  U.  S.  S.,  419 
Bancroft,  U.S.  S.,  31; 
Bandoliers,  340 
Barber  shop,  204 

regulation-  for,  204 
Barium  dioxide,  429 
Barley,  149 
Barley  water,  199 


476 


INDEX 


Barograph,  273 
Barometer,  20 

aneroid  barometer,  20 

cistern  barometer,  20 

mercurial  barometer,  20 
Barracuda,  311 
Baseball,  349 
Bathroom  of  sick  bay,  245 

on  hospital  ship,  334 

waste  sink  in,  246 
Baths,  226 

before  battle,  226 

engineer's  washroom,  227 

soap,  227 

shower  baths,  226 

see  Swimming. 

Bath  water,  decomposition  of,  39 
Battle,  bath  before  battle,  226 
Battle  dressing  stations,  249 
Beadnell,  48 
Beans,  150 
Beck,  41 
Bed  bugs,  324 

Acanthia  lectularia,  324 

diseases  transmitted  by,  325 

hiding  places,  324 

hospital  ship,  332 

laundry,  211 

plague,  carriers  of,  419 

relapsing  fever — carrying,  422 

remedies,  325 
Bedding,  222 

accidents,  226 

airing  of,  223 

hammocks,  222 

vermin  in,  223,  224 
Bed  wetter,  346 
Beds  in  hospital  ship,  332 
Beef,  140 

tapeworm  from,  415 
Belladonna  in  heat  cramps,  373 

in  seasickness,  361 
Belli,  48 
Bends,  21,  291 
Benedict,  34,  134 
Benzene  for  bed  bugs,  325 
Beri-beri,  134,  365 


Berkefeld  filter,  in 

Berson,  16 

Berthing  spaces  on  hospital  ship,  334 

Beyer,  Medical  Director  H.  G.,  U.  S. 

Navy,  395 

Bichloride  of  mercury,  425 
Biggs,  405 

Bilges  under  fire  room,  199 
Bill  of  health,  432 
Birds,  as  food,  140 

as  test  for  carbon  monoxide,  44 
Biscuit,  inspection  of,  165 
Bites  of  venomous  fish,  311 
Bitzke,  404 
Blattidae,  319 
Blindness,  feigned,  34.6 

caused  by  vivid  light,  122 

wood  alcohol,  354 
Blisters,  on  feet,  341 
Blood,  in  heat  cramps,  368 
Blood-pressure,  270,  271 
Blue  ointment,  323 
Boat  races,  349 
Boat  cloak,  180 
Boating,  see  Small  Boats. 
Body  heat,  lost  through  conduction,  171 

evaporation,  171 

radiation,  171 

retained  by  clothing,  1 70 
Bodies  in  cold  storage,  334 
Bohm,  43 
Boiling  point,  18 
Boiling  water,  109,  no 
Bombyx  mori,  168 
Bordet-Gengou  bacillus,  390 
Bottled  drinks,  353 
Boyle's  law,  20 
Boxing  matches,  349 
Bread,  inspection  of,  161 
Breeding  places  for  flies,  65,  325,  343 
Bresset,  142 

Brick,  permeability  of,  46 
Brig,  207 

care  of  prisoners  in,  207 
British,  in  the  Crimea,  128 

in  India,  115 

Kut-el-Amara,  beri-beri,  366 


INDEX 


477 


British,  soldiers  eating  cordite,  355 

treatment  of  exhaustion  psychosis. 

362 
British  Navy,  per  capita  air  space,  48,  49 

recompression  chamber,  291 

stretchers,  255 

theater  ship,  349 

ventilation,  64 
Bromides,  361 
Bromine,  109,  114 
Broncho-pneumonia,  391 
Brown,  Surgeon  E.  W.,  U.  S.  Xavy,  276 
Brown  University,  300 
Bunks  on  hospital  ship,  332 
Bubonic  plague,  419 
Buchner,  121 
Buckwheat,  149 
Bum  boat,  166,  353 
Burial  in  action,  436 

at  sea,  436 

Burning  as  disinfectant,  425 
Burns,  by  gas,  357 

on  submarines,  282 
Butcher  shop,  208 

care  of,  208 

personnel  of,  209 
Butter,  146 

inspection  of,  165 

oleomargarine,  146 

preservation  of,  228 

process  butter,  146 
Buttermilk,  146 
Butter  trier,  165 


Caisson  disease,  21 
Calcium,  in  food,  128 

salts  of,  in  body,  132 
Calcium   carbonate,    -tandard    >olution, 

105 

Calcium  hypochlorite,  100,  114,  300 
Calcutta,  lilac  k  II 
Callionymus  lyra. 
Calmette,  312 

Calorics,  134,  135,  136,  138,  150 
("amp,  breaking,  338 

site,  342 


Canned  foods,  153 

cheese,  153 

meats,  153 

milk,  153 

vegetables,  153 

Candle,  effect  of,  on  atmosphere,  124 
on  eyes,  124 

power,  124 

Canthigaster  rivulatus,  310 
Canvas  litter,  U.  S.  Army,  254 
Captain's  inspection,  376 
Carbolic  acid,  as  disinfectant,  426 
Cardamom,  compound  tincture  of,  354 
Care  of  feet,  340 
Cargo  ports,  55 
Carcharodon  carcharias,  316 
Carbohydrates,  130,  131,  135,  136,  138, 
141,  148,  149,  150,  151,  152 

disaccharids,  131 

monosaccharids,  131 

pentoses,  131 

polysaccharids,  131 
Carbon,  as  carbohydrates,  130 

in  food,  128 
Carbon  dioxide,  30,  33,  38 

concentration  of,  30 

diving,  287 

in  normal  air,  22,  23 

on  ship  board,  38 

on  submarines,  276 

test  for  concentration,  43 
Carbon  disulphide,  426,  427 
Carbon  filament,  life  of,  127 
Carbonic  acid  gas,  41 
Carbon  monoxide,  30,  31,  71,  426,  427 

poisoning,  281,  363 

on  submarines,  279 

test  for,  44 

see  "Gasolene  Jug." 
Carriers  of  disease,  ancyl«>-t«>mia>is,  414 

bed  bugs,  325 

butcher  shop,  209 

cerebro-spinal  fever,  392 

cholera,  417 

cockroaches,  320 

diphtheria,  390 

flies,  328 


478 


INDEX 


Carriers  of  disease,  galley,  201 
laundry,  210 
pneumonia,  402 
submarines,  282 
typhoid  fever,  409,  412 
water  tanks,  81 

Cardio-respiratory  murmurs,  262 
Care  of  men,  in  the  bakery,  204 
barber  shop,  204 
boats  and  boating,  215 
brig,  207 

butcher  shop,  209 
coaling  ship,  213 
engine  room,  194 
fighting  tops,  194 
fire  room,  196 
galley,  201 
handling  room,  199 
laundry,  210 

steering  engine  room,  212 
on  watch,  192 
Carroll,  418 
Celsius,  1 8 

Ceiba  pentendra,  222 
Centigrade,  18 
Cerebrospinal  fever,  375,  391 
bacteriology,  392 
disinfection,  393 
healthy  carriers,  392 
immunity,  392 
in  U.  S.  Navy,  391 
period  of  incubation,  392 
prevalence,  391 
prophylaxis,  393 
Certified  milk,  141 
Cestodes,  415 
Chagas  fever,  325 
Chancroid,  380 
Chavez,  271 
Chausse",  36 
Cheese,  147 

inspection  of,  164 
Chemical  analysis  of  air,  43 

of  water,  92 
composition  of  air,  2 1 
purification  of  water,  109,  113 
Chest,  262,  454 


Chest,  expansion,  455 

measurements,  for  midshipmen,  456 
for  minors,  456 
for  musicians,  apprentice,  456 
'  for  recruits,  264,  455 
Chicken-pox,  376,  399 

bacteriology,  399 

immunity,  399 

period  of  incubation,  399 

prophylaxis,  399 
Chickering,  401,  402 
Chinese  clothing,  advantages  of,  170 
Chittenden,  131,  137 
Chloramine-T,  no,  116,  393 
Chlorine,  element  in  food,  128 

as  fumigant,  426,  427 

to  purify  swimming  tank,  300 

to  purify  water,  77,  109,  114 

on  submarines,  279 

in  water,  92,  103,  108 

water,  211 

Chlorinated  lime,  118 
Chlorpicrin,  322 
Chlorophyl-bearing  algae,  86 
Cholera,  3,  376,417,432 

incubation,  417 

immunity,  417 

prophylaxis,  417 

spirillum  cholerae  asiaticae  in  milk, 

142 

in  water,  93 
Cigarette,  352 
Cinders,  41 

in  eyes,  194 
Cisterns,  88 
Citronella,  408 

Citrous  fruits,  inspection  of,  104 
Cladothrix,  86 

dichotoma,  96 
Clams,  155,  156 

poisoning  by,  156 
Clark  soap  method,  105 
Clark  scale,  83 
Clothing,  1 68  I 

articles  of,  in  U.  S.  Navy,  173 

aviator's  clothing,  189 

body  heat,  retained  by,  170 


479 


Clothing,  color  of,  172 
definition  of,  ids 
extra  hea\  \  . 
foot  gear,  1X4 
head  gear,  180 
loan  of,  352 
materials  for,  168 
protection  from  heat,  173 
rain  clothes,  184 

»  socks,  187 
sources  of,  168 
uniforms,  174 

\\orn  by  engine-room  force,  196 
fire-room  force,  198 
physician  attending  plague,  420 
Coal  dust,  41 

Coal  passers,  requirements  for,  450 
Coaling  ship,  213 
l»and,  214 

clothing  of  men,  214 
danger  of,  213 
first-aid  parties,  214 
<°la,  354 
Cocaine,  355 

.  376 

Cockroaches,  Ulattidre,  319 
Croton  bug,  320 
and  Hies,  327 

(ierrnan  eorkroarhes,  201,  203,  319 
jet  from  steam  hose,  320 

P«  <2O 

remedies,  320 
spread  disease,  320 
traps.  320 
Cocoanuts,  354 

tilled  with  rum,  354 

353 
Coffini 

CohK  404 
Cold  -l 

iie  creM 

im  permit 
Refrigeration. 
Cole,  401,  402 
Collodion. 

Color,  absorption  of  heat.  172    i  ~  + 
of  light,  123 


Color,    perception,     determination     of, 

259,  452 

Holmgren  method,  259,  452 
Jennings  method,  259 

visibility  of,  172,  177 
Color  blindness,  259 
Common  use  of  brush,  352 

comb,  352 

pipe,  352 

razor,  352 

tobacco  bag,  352 

towel,  352 
Compartments  of  ship,  7,  10 

advantages  of,  10 

disadvantages  of,  10 
Compressed  air,  on  submarines,  279 
Compulsory  inoculation  for  typhoid,  410 
Concurrent  disinfection,  423 
Conduction,  70,  171 
Confectionery,  152 
Conjunctivitis,  214 

on  submarines,  282 
Constipation,  234 
Convection,  70 
Cooper-Hewitt  or  mercury  vapor  lamp, 

125,  126,  127 
Copper,  in  water,  108 
Coral  polyps,  315,  316 
Cordite  eating,  355 
Corrosive  sublimate,  425 
Corn,  hominy,  149 

popcorn,  149 

samp,  149 
Corns,  341 
Coronium,  29 
Cottle,  Surgeon,  U.  S 
Cotton,  169 

comparison  with  linen,  172 

te>t  for,  170 

.1  oil,  151 
Cottiiv  gobio.  si  -1 
Coullier,  172 
Courbet,  53 
Cowls,  mushroom,  53 
Crab  louse,  321,  323 

extermination  of,  323 
Cntg,  419 


480 


INDEX 


Cramps,  301,  367 

Cream,  146 

Creolin,  426 

Cresol,  426 

Critical  temperature,  19 

Croce-Spinelli,  16 

Croton  bug,  320 

Croton  oil,  used  by  malingerers,  347 

Crotum  tiglium,  311 

Crude  oil,  409 

Crustaceans,  311 

Culex  fatigans,  419 

pipiens,  419 
Culicidae,  406 
Culture,  taking,  389 
Cups,  covered,  375 
Cuspidors,  376 

self -flushing,  377 

spit  kids,  376 

care  of,  378 
Cyclops  tenucornis,  86 

Daily  average  of  sick,  439 
Dakin,  118 
Dale,  U.  S.  S.,  316 
Daphnia,  86 

Darnall  Siphon  Filter,  118 
Davies,  153 
Dead  lights,  125 
Dead,  burial  in  action,  436 
at  sea,  436 

disposal  of  the,  434 
on  shore,  436 

embalming,  434 
solution,  435 
Death  by  shark  bite,  316 
Decompression  in  diving,  291 
Deep  ground  or  artesian  water,  83,  85 

wells,  90 

Deep  water  diving,  see  "Diving." 
Deformed  feet,  338 
Dejecta,  disposal  of,  339 
Dengue,  419 

immunity,  419 

period  of  incubation,  419 

prevention,  419 
Dentist's  office  on  ship  board,  248 


Description  of  recruit,  264,  462 
Detention  of  ships  from  plague-infected 

ports,  421 
Dextrose,  131 

Diagnostic  work  in  hospital  ship,  332 
Diarrhoeal  symptoms;  feigned,  346 
Dibothriocephalus  latus,  416 
Dichlorethylsulphid,  357 
Diffusion,  50,  51 
Digestive  disturbances,  282 
Diphenyl-chlorarsin,  358 
Diphtheria,  3,  142,  376,  384 
bacteriology,  384 
carriers,  390 
carriers  in  galleys,  202 
epidemic  form,  384 
examination  of  all  hands,  385 
handling  an  outbreak,  385 
mode  of  transmission,  385 
period  of  incubation,  385 
specific  cause  of,  in  milk,  143 
taking  the  culture,  389 
toxin-antitoxin,  389 
Vincent's  angina,  mistaken  for,  390 
Diplococcus  intracellularis  meningitidis, 

376,  39i 

Disease  carriers  see  "Carriers  of  Disease." 
Disease,  from  laundry,  211 

water-borne,  on  ship  board,  8 
Diseases,  heat  cramps,  367 
infectious,  379 
nervous  system,  362 
nutritional,  365 
sea  sickness,  359 
sputum  borne,  374 
Diseases,  infectious,  379 

ancylostomiasis,  412 
cerebrospinal  fever,  391 
chicken-pox,  399 
cholera,  417 
dengue,  419 
diphtheria,  384 
dysentery,  414 
German  measles,  391 
jaundice,  infectious,  422 
malaria,  405 
Malta  fever,  422 


INDEX 


481 


Diseases,  measles,  394 

mumps,  400 

plague,  419 

pneumonia,  401 

relapsing  fever,  422 

requirements  to  fight,  379 

scarlet  fever,  396 

small-pox,  398 

tapeworms,  415 

trench  fever,  421 

tuberculosis,  403 

typhoid  fever,  409 

typhus  fever,  422 

venereal  diseases,  379 

whooping  cough,  390 

yellow  fever,  418 
Disinfection,  423 

bichloride  of  mercury,  425 

barium  dioxide,  429 

boiling,  424 

burning,  425 

carbolic  acid,  426 

carbon  disulphide,  426,  427 

carbon  monoxide,  426,  427 

chemical,  423,  425 

chlorine,  426 

for  cholera,  417 

concurrent,  423 

dry  heat,  424 

flaming,  424 

formaldehyde,  426,  428 

formalin,  426 

^a>eous  disinfectants,  426 

hydrocyanic  acid,  426 

physical,  423,  424 

potassium  permanganate,  429 

preparation  for,  427 

quarantine,  432 

of  ships,  425,  427 

of  sputum,  374 

chemical  means,  375 

physical  means,  374 
steam  under  pressure,  424 
streaming  >team,  4^4 
sulphur  dioxide.  4^0.  450 
sunlight,  4 25 
terminal,  36,  423 

31 


Disinfection,  for  vermin,  431 
Dispensary  on  hospital  ship,  334 

on  ship  board,  242 
Disposal  of  the  dead  on  shore,  436 
Distance  covered  marching,  339 
Distillation,  8,  77,  109,  no 

of  water,  109,  no 
Distilled  water,  78 
Diver's  palsy,  21 
Dives,  high,  dangers  of,  300 
Diving,  284] 

atmospheric  pressure,  284 

bends,  291 

care  of  diver,  290 

danger  of  too  rapid  decompression, 
290 

dress,  285,  289 

excessive  inflation  of  dress,  289 

man's  endurance,  284 

nervous  system,  291 

on  submarines,  290 

physical  requirements,  291 

squeeze,  289,  290 

symptoms  of  too  rapid  decompres- 
sion, 291 

water  pressure,  287 
Dochez,  401,  402 
Dogs,  feeding  tests  on,  309 

tape- worm,  417 

Dollard,  Surgeon  H.  L.,  U.  S.  Navy,  447 
Drafts,  46 
Drift  gas,  357 
Drills,  "setting  up,"  351 
Drinking  water,  351 

in  engine  room,  196 

in  fire  room,  198 
Drowning,  293,  303 
Drug  addicts,  338 

habits,  354 

Dry  heat  as  disinfectant,  424 
Drydock,  sewage  disposal  in,  235 
Dunbar-Brunton,  313 
Dungarees,  180 
Dunham,  118 
Dust,  bacteria  spread  by,  42 

from  chipping  paint,  42 
coal,  41 


482 


INDEX 


Dust,  powder  explosions,  42 

sawdust,  42 

street,  41 
Dysentery,  3,  352,  414 

amoebic,  415- 

bacteriology  of,  414 

prevalence  of,  414 

prophylaxis,  415 

screens,  415 

specific  cause  of,  in  milk,  143 

symptoms  feigned,  346 

vaccination  for,  414 

Eagle  ray,  313 
Ears,  261,  452,  453 

in  aviation,  267 

in  diving,  300 

in  submarines,  281 
Echinoderms,  313 
Edible  fungi,  152 

mushrooms,  152 

truffles,  152 

Edridge-Green  lamp,  259 
Eggs,  147 

cause  of  disease,  147 

cold  storage,  228 

fish  roe,  147 

inspection  of,  162 

preserved,  147 
Eggs  of  insects,  bed  bugs,  324,  325 

cockroach,  German,  320 

flies,  325 

lice,  321,  322,  323,  324 
Eijkman,  134,  365 
Elasmobranchii,  Dasybatidae,  313 

Myliobatidae,  313 
Elbert,  322 
Electric  blowers,  69 

heating,  71,  72 
submarines,  74 

lamps,  125 
arc,  125 

carbon  filament,  127 
Cooper-Hewitt,  125,  127 
Nernst,  127 
tungsten,  125,  126,  127 

light,  124 


Electric,  candle  power,  124 

holophane  shade,  125,  127 

ovens,  ii 
Electricity,  7 

application  of,  1 1 

benefits  of,  on  ship  board,  9,  n 
Elevator  shafts,  55 
Elliot,    Medical    Director    M.    S., 

U.  S.  Navy,  317 
El  Mirti  in  the  Andes,  16 
Elser,  392 
Embalming,  434 

solution,  435 

Endamoeba  histolytica,  415 
Energy  supplied  by  fat  and  carbohy- 
drate, 131 
Engine  room,  194 

drinking  water,  196 

temperature  of,  194 

ventilating  system,  194 

wash  room,  227 
Engineer's  force,  bedding  of,  224 

care  of,  196 

clothing  of,  198 

diseases  of,  196 

Engineer's  wash  room,  226,  227 
Enlisted    men's   clothing,   Arctic  over- 
shoe, 187 

extra  heavy  clothing,  187 

foot  gear,  184 

head  gear,  183 

mackintosh  suit,  188 

mittens,  188 

pea  coat,  180 

rain  clothes,  184 

socks,  187 

uniforms,  174,  177,  iJ 
Enteric  fever,  322 
Epilepsy,  362 

dangers  to  epileptics,  363 

feigned,  345 
Epileptic  fits,  258 
Erysipelas,  142 
Erythropsia,  123 
Escape      apparatus,     on     submarines, 

282 
Ether  extract,  148,  149 


INDEX 


483 


Ethylhydrocuprein    hydrochloric] e   in 

pneumonia,  403 

Etiology  of  ancylostomiasis,  413 
dengue,  419 
dysentery,  amoebic,  415 

bacillary,  414 
infectious  jaundice,  422 
malaria,  405 
relapsing  fever,  422 
seasickness,  359 
smallpox,  398 
tapeworm,  415 
trench  fever,  421 
yellow  fever,  418 
Suphos,  patented  glass,  126,  272 
Evaporation,  171 
Examination  of  aviators,  267 

recruits,  257 
Exhaust  systems  of  artificial  ventilation, 

60,  62 

Extermination  of  insects,  bed  bugs,  325 
cockroaches,  320 
flies,  327 
lice,   pediculus   corporis,   or    vesti- 

menti,  322 

prdiculus  humanus,  324 
phthirius  pubis,  323 
Eye  strain,  on  submarines,  123,  282 
Eyes,  blindness  from  wood  alcohol,  354 
cinders,  194 

color  perception,  259,  452 
conjunctivitis,  282 
examination  of,  258 
for  aviation,  267 
injury  from  bright  light,  122,  192 

candle  light,  i  24 
retinal  hypera^sthesia,  194 
rctinitis,  193 
\  i>ual  acutcness,  test  for,  260,  451 

Face,  453 

Face  mask,  for  aviators,  190 
Fahrenheit,  17 
Farinaceous  foods,  148 

barli-y,  149 

buckwheat,  149 

(.urn,  149 


Farinaceous  foods,  flour,  148 

oats,  149 

rice,  149 

rye,  149 
Farinaceous  preparations',  151 

arrowroot,  151 

sago,  151 

tapioca,  151 
Fasciola  gigantea,  376 
Fat,  melting  point  of,  132 
Fats,  130,  132,  135,  136,  138,  141,  146, 

150,  151 
Fatty  seeds,  151 

cotton  seed  oil,  151 

nuts,  151 

olive  oil,  151 
Fecal  impaction,  351 
Feet,  deformed,  338 

care  of,  while  marching,  340, 341 , 342 

trench  foot,  343 
Fever,  cerebrospinal,  391 

Malta,  422 

relapsing,  422 

scarlet,  396 

trench,  421 

typhoid,  409 

typhus,  422 

yellow,  418 
Field  hospital,  334 
Fighting  tops,  care  of  men  in,  194 
Filipinos,  physical  proportions  of,  455 
Filth  diseases,  409 

and  the  cockroach,  320 
Filtration,  109.,  in 

domestic,  109,  in 

into  wells,  91 

municipal,  109,  112 

slow  sand,  109,  112 
Finger  prints,  460,  464 

apparatus  for,  464 

directions  for  taking,  465 

of  the  drowned,  471 

plain  impressions,  464 

rolled  impressions,  464 
Fire  room,  196 

bathing  facilities,  226 

bilges  under,  199 


484 


INDEX 


Fire  room,  disease  in,  198 

drinking  water,  198 

forced  draft,  196 

health  in,  198 

natural  draft,  196 
Firemen,  requirements  for,  450 
Fire-step,  343 
Fires,  on  the  march,  338 
First  aid  coaling  ship,  214 
Firth,  71 
Fish,  153 

clams,  155,  156 

inspection  of,  154    . 

lobsters,  155 

mussels,  155 

oysters,  155     :' 

poisonous,  309 

bites  of  venomous,  311 
flesh  of,  309 

poison  glands  in,  311,  312 
varieties  of,  309-315 

preservation  of,  228 

tapeworm  from,  416 

water  polluted  by,  82 
Fisher,  36 
Flack,  29,  285 

Flaming  as  disinfectant,  424 
Flat  foot,  457 

on  the  march,  338 
Fleas,  419 

Ceratophyllus  faciatus,  420 

Xenopsylla  cheopis,  419 
Flemming,  16 
Flexner- Strong  type,  414 
Flies,  325 

breeding  places  for,  65,  325,  343 

in  camps,  327 

and  cholera,  417 

disease  spread  by,  328 

and  dysentery,  415 

free  steam,  327 

manure,  327 

Musca  domestica,  325 

poison  baits,  327 

and  poliomyelitis,  328 

remedies  for,  327 

Stomoxys,  calcitrans,  328 


Flies,  traps,  327 

Flights  of  great  altitude,  271 

Flour,  148 

graham,  148 

white,  148 
Flugge,  143 
Flukes,  376 

lung,  376 
Fly  larvae,  328 
Fly  screens  in  bakery,  204 

in  butchershop,  208 
Fomites,  397,  400,  418 
Food,  128 

average  diets,  136 

bulky,  138 

butter,  146 

calories,  134 

canned  foods,  153 

carbohydrates,  131 

cheese,  147 

eggs,  147 

elements  necessary  in,  128 

fats,  132 

fish,  153 

meat,  139 

milk,  140 

minimum  on  ships,  128 

much  food  unwholesome,  129 

need  of,  128 

nutritional  diseases,  134,  365 

oysters,  155 

refrigeration  of,  227 

proteins,  130 

requirements  for  good,  129 

salts,  132 

soldiers  on  active  maneuvers,  136 

sources  of,  138 

U.  S.  Navy  ration,  138 

vegetable  foods,  148 

vitamines,  133 

water,  134 

Food,  practical  inspection  c 
biscuit,  165 
bread,  161 
bum  boat,  166 
butter,  165 
cheese,  164 


INDEX 


485 


Food,  eggs,  162 
t~i-h,  154 
fruits,  164 

green  vegetables,  163 
meat,  162 
milk,  165 
potatoes,  163 
vegetables,  164 
Foot-and-mouth  disease,  142 
Foot  ball,  349 
Foot  gear,  184,  187 
Foot,  flat,  263 
Ford,  W.  W.,  143,  144 
Ford,  C.,  339 
Formalin,  426 

for  flies,  327 
Formaldehyde,  426,  428 
Foster,  28,  136 
Francis,  434 
Frankland,  93 
Freezing  point,  18 
Fresh  fruit,  preservation  of,  228 
French  Army,  405 
French,  Surgeon,  U.  S.  Navy,  285 
Frost-bite,  343 
Fruits,  152 

apples,  152 

bananas,  152 

berries,  152 

cherries,  152 
152 

inspection  of,  164 

melons,  152 

peaches,  152 

pears,  152 

plum<.  i 

oranges,  152 
Fruits  as  vegetable-. 

cucumbers,  152 

egg  plant,  152 

pumpkins,  152 

squash,  152 

tomatoes,  152 

Fuel  oil,  fumes  of  on  submarines,  279 
Fumigants,  for  mosquitoes,  408 
Fumigation,  against  lire  in  trench  fever, 
421 


Fumigation   of  ships  in   plague  ports, 

421 

see  "Disinfection." 
Funk,  133,  365 

Galactose,  131 

Galley,  care  of  the,  200,  201 

personnel  of,  201 

on  hospital  ship,  334 
Gangrene,  frost-bite,  344 

trench  foot,  343 
Ganot,  126 

Garbage,  disposal  of,  237 
Garbage  bin,  fly  proof,  240 

bill  of  materials  for,  241 
Garments,  tight-fitting,  340 
Gartner,  318 
Gas,  aqueous  vapor,  23,  37,  38 

batteries,  storage,  38,  40 

carbonic  acid,  41 

carbon  dioxide,  23,  43 
monoxide,  44,  279 

of  decomposition,  37,  39 

dichlorethyl  sulphid,  357 

drift,  357 

from  gasolene,  37,  39 

from  gunfire,  37,  38 

hydrogen,  278 

illuminating,  124 

intestinal,  38,  41 

introduced  by  Germans,  357 

lacrimatory,  357 

lethal,  357 

masks,  358 

methane,  38 

mustard,  357 

nitrogen,  23 

oxygen,  22 

poison,  357 

pollutions  of  air,  37 

prophylaxis,  358 

-hells,  357 

ship  in  cloud  of,  358 

>mv/ing,  358 

storage  batteries,  38,  40 

-tored  coal,  37,  38 

stored  powder,  37,  38 


486 


INDEX 


Gas  stoves,  71 

turpentine,  37,  40 

water  closets,  38,  40 
Gasolene,  carbon  monoxide,  281 

fumes,  37,  39,  215 

gasolene  "jag,"  39,  216,  281,  355 

torch,  325 

Gastroenteritis,  148,  417 
Gastrointestinal  infections,  142 
Gatewood,  22,  28,  48,  293 
Geddings,  425 
German     cockroach,     201,     203,    319, 

428 

German  measles,  376,  391 
German  Navy,  air  space  per  capita,  48 

ration,  138 
Germans,  disposal  of  dead,  437 

introduced  poison  gas,  357 

ground  glass  in  candy,  153 
Germicide,  sulphur  dioxide  as,  430 
Germs  in  air,  35 
Gin,  354 

Glassblower's  cataract,  122 
Glossary  of  nautical  terms  used,  4^1 
Glucose,  131 
Glycogen,  131 
Goatfish,  311 

Goats  and  Malta  fever,  422 
Goggles,  190,  193 
Goiter,  262,  263 
Goldberger,  394 
Gold  fish,  285 
Gonorrhoea,  263,  352,  380 
Grab  line,  301 
Graves,  large,  436 

construction  of,  436 
Green  vegetables,  inspection  of,  163 
Greene,  Major  Ralph,  U.  S.  A.,  270 
Greiss,  100 
Ground    squirrels,    carriers    of   plague, 

420 

Ground  water,  in  wells,  84,  90 
Grow  unlearnable  card,  260 
Gun  pointers,  test  of  vision,  261 
Guinea-pigs,  for  diagnostic  work,  332 
Gunn,  322 
Gun-ports,  55 


Habits,  meals,  351 

bowel,  351 

Haemic  murmurs,  262 
Haemosporidia,  405 
Haffkine's  prophylactic,  420 
Hall,  290 
Halogen  group,  109,  114 

bromine,  109,  114 

chlorine,  109,  114 

iodine,  109,  114 
Halozone,  118 
Halt,  the,  339 
Hamilton,  in 

Hammer  toe,  on  the  march,  338 
Hammock,  222 

nettings,  222 

Handkerchiefs,  paper,  375 
Handling  room,  199 
Hands,  262 

Harbors,  fouling  of,  237 
Hardness  of  water,  82,  83,  92,  105 

Clark  method  for  estimation,  105 

permanent,  85,  86,  106 

temporary,  85,  106 
Hargrave,  Surgeon  W.  W.,  U.  S.  Navy, 

3ii 

Harrington,  71,  113,  114 
Hatches,  52/53 

Head,  examination  of,  258,  453 
Head  gear,  180 

cork  pith  helmet,  183 

for  plague  attendants,  420 

sailor  hat,  183 

watch  cap,  183 

white  hat,  183 
Heads,  water  closets,  229 

number  required,  229,  231 
Health  record  of  patient,  336 

instructions  concerning,  459 
Heart,  262,  352 

cardio-respiratory  murmurs,  262 

haemic  murmur,  262 

tachycardia,  263 
Hearing,  452 

on  submarines,  281 
Heat  absorption,  influence  of  color  on, 
172 


murs,  262 


INDEX 


487 


I 


Heat,  production  on  march,  338 
by  protein,  131 

radiation,  on  the  march,  340 

in  trench  foot,  343 
Heat  cramps,  367 

blood,  368 

cases  of,  368,  369,  370 

causes  of,  367 

prophylaxis,  372 

report  of  full  power  run,  371 

symptoms  of,  367,  368,  369,  370 

temperature,  368 

treatment,  373 

urine  in,  368 

Heat  exchange  apparatus,  109,  no 
Heat  rays  in  tropics,  127 
Heat  stroke,  cause  of,  19 
Heating   70 

conduction,  70 

convection,  70 

electricity,  72,  74 

gas,  stoves  and  fires,  71 

history  of  on  ship  board,  9 

hot  air,  71 

hot  water,  72 

open  fires,  70 

radiation,  70 

steam,  72 

stoves,  71 
Heating,  systems  of,  72 

aboard  ship,  73 

direct,  72 

direct-indirect,  72 

history  of  aboard  ship,  9 

hospital  ships,  334 

indirect,  72 

on  submarines,  74 

thermo-ventilation,  73,  334 

thermo-tank,  74 
Height,  midshipmen,  456 

minors,  456 

musicians  (apprentice),  4S<> 

recruits,  264,  455 
Heiser,  365 
Jli-lium,  29 
JK-llriegel,  28 
Helmet,  for  aviators,  189 


Hemiptera,  324 
Herbaceous  articles,  152 

cabbage,  152 

celery,  152 

cresses,  152 

inspection  of,  164 

lettuce,  152 

onions,  152 

Hermes  sewage  ejector,  235 
Hernia,  258,  263 

from  boating,  218 

among  fire  room  force,  198 

from  seasickness,  360 
Hess,  391 
Higgins,  44 
High  dives,  300 

dangers  of,  300 
Hill,  29,  33,  285 
Hiqueru,  284 
Hog  tapeworm,  416 
Holmgren  method,  color  perception,  452, 

259 
Hominy,  149 

samp,  149 
Honey,  152 
Hookworm,  414 

see  Ancylostomiasis. 
Hopkins,  133 
Hospital  fund,  439 
Hospital  ship,  329 

bacteriological  laboratory,  332 

baths,  334 

bed  bugs,  332 

berthing  spaces,  334 

bunks  or  beds,  332 

construction  of,  330 

dark-room,  332 

deck  force,  329 

disinfecting  plant,  334 

dispensary,  334 

di-tilling  plant,  331 

engineer's  force,  330 

galleys,  334 

ice  machine,  333 

infectious  ward,  332 

laundry,  334 

lounging  room,  334 


488 


INDEX 


Hospital  ship,  mortuary  room,  332 

motor  boats,  335 
as  ambulances,  335 

oil  burner,  335 

operating  room,  332 

pantries,  334 

passages,  331 

pathological  laboratory,  332 

personnel  of,  329 

psychopathic  ward,  333 

refrigerating  plant,  334 

smoking  room,  334 

speed  of,  331 

transfer  of  patients,  335 

venereal  ward,  333 

wards,  331 

X-ray  room,  333 
Hot  air,  71 

Hot  water  heating,  71,  72 
Hours  for  swimming,  300 
Houston,  421 
Huber,  271 
Humidity,  21,  50,  51 

relative  humidity,  24 
Hummel,  320 
Hunt,  362 
Huntoon,  392 
Hutchinson,  36 
Hydrate  of  iron,  no,  115 
Hydrocele,  263 
Hydrocyanic  acid,  426 
Hydrogen,  explosion  from,  41 

in  food,  128 

on  submarines,  278 
Hygiene,   application  of   principles    of, 

2 

definition,  i 

early  Naval,  4 

influence    of    Naval    Architecture, 

7 
Hygiene,  personal,  348 

alcoholic  beverages,  353 

amusement,  348 

athletics,  349 

bottled  drinks,  353 

bum  boats,  353 

cigarettes,  352 


Hygiene,  cleanliness,  350 

coffee,  353 

concerts,  350 

contentment,  348 

cordite  eating,  355 

drinking  pure  water,  351 

gambling,  348 

gasolene  jag,  355 

habit  producing  drugs,  354 

lectures,  350 

loan  of  personal  property,  352 

moving  pictures,  349 

paper  towels,  351 

regular  evacuation  of  bowel,  351 

regular  meals,  351 

setting  up  drills,  351 

shellac,  354 

spirituous  liquors,  353 

tattooing,  355 

theatrical  performances,  349 

tobacco,  352 

tobacco  bag,  352 

tooth  brushes,  352 

underclothing,  351 

U.  S.  Navy  Morbidity  lists,  348 
mortality,  348 

wash  basins,  351 

water  closets,  351 

wood  alcohol,  354 

work,  348 
Hygrometer,  24 
chemical,  24 
condensing,  24 
hair,  24 

psychrometer,  24,  25 
Hysterical  manifestations, 

Ice  cream,  8 
Ice  machine,  229,  333 
Identification  records,  460 
Illumination,  122 

artificial,  122 

direct,  123 

electricity,  124 

excessive,  123 

gas,  124 

handling  room,  199 


INDEX 


489 


Illumination,  indirect,  123 

location  of  lights,  127 

natural,  122 

number  of  foot  candles,  124 

shipboard,  125 
Immunity,  cerebrospinal  fever,  392 

chicken-pox,  399 

cholera,  417 

dengue,  419 

dysentery,  414 

German  measles,  391 

malaria,  406 

measles,  394 

mumps,  400 

plague,  420 

pneumonia,  402 

scarlet  fever,  396 

small-pox,  398 

trench  fever,  421 

tuberculosis,  404 

typhoid  fever,  410 

whooping  cough,  391 

yellow  fever,  418 
Inada,  422 

Incineration  of  bodies,  436 
Incrustants  in  water,  107 
Incubation,     period     of,     cerebrospinal 
fever,  392 

chicken-pox,  399 

cholera,  417 

dengue,  419 

diphtheria,  385 

German  measles,  391 

mraslrs,  394 

mumps,  400 

re-lapsing  fever,  422 
^96 

>mall-pox,  398 

trench  fever,  421 

whooping  cough,  390 

yellow  fever,  418 
India,  food  of,  138 

Infectious  diseases,  see   Diseases,  infec- 
tious. 

Infectious  ward  on  hospital  ship,  332 
Infra-red  rays,  121 
Inguinal  region,  263 


Inoculations,  anti-typhoid,  409,  410,  411 
Insect  powders,  325 
Insects,  319 

as  disease  carriers,  43,  399 
bed  bugs,  324 

diseases  carried  by,  325 
remedies  for,  325 
cockroaches,  319 

diseases  carried  by,  320 
remedies,  320 
flies,  325 

diseases  carried  by,  328 
remedies,  327 
lice,  320 

disease  carriers,  321,  322,  422 
extermination  of,  322,  323 
pediculus  corporis,  321 
pediculus  pubis,  323 
pediculus  vestimenti,  321 
phthirius  pubis,  323 
mosquitoes,  405 
ventilating  system,  43,  61,  64 
Insecticide,  sulphur  dioxide  as,  430 
Instruction  in  aviation,  271 

in  swimming,  293 
Intestinal  gas,  38,  41 
obstruction,  351 
Iodine,  109,  114 

salts  of,  in  body,  132 
Iron,  in  food,  128 

salts  of,  in  body,  132 
Isobars,  21 

Isolation  ward  on  ship  board,  247 
Isotherms,  19 
Italian  Navy,  per  capita  air  space,  48,  49 

Jacob's  ladder,  218 
Japanese  rice  diet,  137 
Japanese  Navy,  366 
Jaundice,  infectious,  422 

cause  of,  422 

prophylaxis,  422 
Jelly-fish,  314 

poisoning  by,  314,  315 

protection  from,  315 
Jennings  method,  259 
Joints,  examination  of,  263 


4QO 


INDEX 


Jumper,  174,  1 77 
Jutland,  Battle  of,  67 

Kala-azar,  32^ 

Kayser,  409 

Keeping  step,  340 

Keno toxin,  32 

Kent,  266 

Kerosene  kills  bed  bugs,  325 

kills  lice,  323 
Kidney  lesions,  372 
Kidneys,  acute  irritation  in  heat  cramps, 

368 
Kindleberger,  Medical  Director  C.  P., 

U.  S.  Navy,  315 
Koch,  94,  403 
Kolmer,  402 

Kress,  Surgeon,  U.  S.  Navy,  277,  282 
Krypton,  29 

Labredo,  366 

Lacrimatory  gases,  357 

Ladders,  199 

Ladysmith,  ration  during  siege,  135 

Lagging,  194 

Lagocephalus  laevigatus,  310 

Lamb,  140 

Lamps,  effect  of  on  atmosphere,  1 24 

Landing  party,  337 

Lane-Claypon,  142 

Latham,  272 

Latrines  in  camp,  343 

fly  proof,  327 

on  the  march,  338 
Launching  the  aviator,  275 
Laundry,  the,  210 

chlorine  water,  211 

disinfecting  plant,  334 

on  hospital  ship,  334 

linen  from  sick  bay,  210 

sprinkling  clothes,  211 

vermin  in,  211 
Lavender,  oil  of,  408 
Laveran,  405 
Lazear,  418 
Lead  poisoning,  35 

in  water,  108 


Le  Dantec,  315 
Legumes,  150 

beans,  150 

lentils,  150 

peas,  150 

Lelean,  233,  327,  411 
Lentils,  150 
Leprosy,  432 
Leptothrix,  86 
Lethal  gases,  357 

bromine,  357 

chlorine,  357 

hydrocyanic  acid  gas,  357 

phosgene,  357 

trichloro-methyl-chlorof ormate,  357 
Levulose,  131 
Lice,  263,  320 

disease  carried  by,  321,  322 

eradication   of   pediculus   corporis, 

322,  323 

phthirius  pubis,  323 
pediculus  humanus,  324 

in  Navy,  320 

in  relapsing  fever,  422 

in  trench  fever,  421 

varieties  of,  321 
Life  lines,  193 
Light,  1 20 

aboard  ship,  125 

absorption  by  colors,  1 23 

actinic  rays,  122 

bactericidal  power  of,  122 

definition  of,  120 

electricity,  124 

electro-magnetic  theory  of,  1 20 

emission  theory  of,  120 

gas,  124 

in  tropics,  127 

infra-red  rays,  121,  122 

injury  to  eyes,  122 

ultra-violet  rays,  121 

undulatory  theory  of,  120 

see  Illumination. 
Lights,  aboard  ship,  10 
Lime  juice  for  scurvy,  365 
Linen,  170,  171 

advantages  of,  172 


INDEX 


491 


inen,  test  for,  170 
The  "Londonderry,"  48 
Lordosis,  258 

Lounging  rooms  on  hospital  ship,  334 
Lower  extremities,  263 
Lundell,  421 

Lung  apron  stretcher,  256 
Lungmotor,  308 
Lungs,  262 
Lysol,  426 
Lyster  bag,  117,  119 

McCloy,  421 

Mi  Collam,  396 

McCollum,  134 

McCoy,  420 

McCreery,  73 

McDowell,  Surgeon,  U.  S.  N.,  281 

M.  Entee,  Naval  Constructor,  U.  S.  N., 

P276 
Mackie,  422 

Mackintosh  suit,  188,  191 
Magazines,  cooling  of,  229 
Maggot,  325 
Magnesium  in  food,  128 

salts  of,  in  body,  132 
Magnesium  sulphate,  361 
Malaria,  3,  405 

ivo-autumnal,  405 
cause,  405 
immunity,  406 
mosquito,  405 
prophylaxis,  general,  406 

onal,  408 
quartan,  405 
tertian,  405 
transmission,  406 
volatile  oils,  408 

I  Malingering,  345,  346 
bed  wetters,  uf) 
blindness,  346 
defective  hearing,  347 
diarrhd-al  symptoms  fcigiu-d,  346 
dysenteric  symptoms  feigned,  346 
exaggerated  defects,  345 
feigned  disease,  345 
mental  disorders  feigned,  347 


Malingering,  myalgia,  347 

self-mutilation,  346 

skin  eruption,  347 

tapeworm,  feigned,  347 
Mai  lory,  396 
Malta  fever,  142,  422 

cause  of,  422 

prophylaxis,  422 
Maltose,  131 
Man's  needs,  air,  46,  47,  50 

water,  76 
Mannose,  131 
Mansfield,  135 
Manure,  327 
Marantonio,  280 
Marcgravia  grunniens,  312 
March,  on  the,  337 

alcohol  addicts,  338 

at  night,  339 

beginning  the,  338 

breaking  camp,  338 

camp  site,  342 

clothing,  340 

cold  weather,  340 

convalescents,  338 

disposal  of  dejecta,  339 

distance  covered,  339 

drug  addicts,  338 

exclusion  from,  337 

feet,  care,  340 
corns,  341 
shoes,  341 
socks,  34  r 
toe  nails,  342 

halts,  339 

heat  production,  338 

latrines  and  urinals,  343 

loose  clothing,  340 

music  while  marching,  340 

picket  lines,  343 

route  step,  340 

those  having  deformed  feet,  338 

those  having  infectious  disease,  338 

too  fat,  337 

too  old,  337 

too  young,  337 

trench  foot,  343 


4Q2 


INDEX 


March,  trench  kidney,  344 
nephritis,  344 

underclothing,  339 

water  supply,  342 

warm  weather,  340 
Marine  animal  life  dangerous  to  man,  309 

bites  or  stings  of  venomous  fishes, 

3n 

grand  trauma,  316 
ingestion  of  poisonous  flesh,  309 
post-mortem  decomposition,  318 
shark  bite,  316 
species  of  poisonous  fish,  309 
Marine  Corps,  physical  examination  of 

recruits,  447,  471 
Marine  uniform,  172 
Marlatt,  325 
Marriott,  44 
Martin,  420 

Materials  for  clothing,  168 
animal  kingdom,  fur,  169 
leather,  169 
silk,  168 
wool,  1 68 

vegetable  kingdom,  169 
cotton,  169 
linen,  170 
other  fibers,  168 
Mattress,  222,  226 
Mattress  covers,  224 
Maxwell,  120 
Measles,  376,  394 

disinfection,  395,  396 
immunity,  394 
incubation,  394 
mode  of  transmission,  394 
predisposition  to  pulmonary  infec- 
tions, 395 
prophylaxis,  394 
Measles,  German,  376,  391 
broncho-pneumonia,  391 
immunity,  391 
incubation,  391 
mode  of  transmission,  391 
prophylaxis,  391 
Measurements,  264 
Meat,  139 


Meat,  beef,  140 

birds',  140 

bull,  140 

fish,  153 

frozen,  162 

good,  139,  140 

inspection  of,  139,  162 

lamb,  140 

mutton,  140 

preservation  of,  228 

veal,  140 
Mechanical  devices  for  resuscitation  of 

apparently  drowned ,  307 
Medical  officer,  duties  of,  50,  81,   166, 
198,    206,   207,   208,   210,   214, 
223,   231,  329,   337,  342,   345, 
366,  439,  448,  450,  456,  458 
Memphis,  U.  S.  S.,  303 
Mendel,  133 
Meningococcus,  42,  392 
Mercury  vapor  lamp,  125 
Meteoric  water,  83,  88 
Methane,  38 
Mexican  tabardillo,  422 
Mice  for  diagnostic  work,  332 

as  test  for  carbon  monoxide,  44 
Micrococcus  melitensis,  422 
Midshipmen,  physical  standard  for,  456 
Milk,  140,  390 

adulterations  of,  141 

bacteria  in,  143 

bacteriology  of,  142 

boiled  milk,  142,  146 

experiments  on  children,  142 

buddeizing,  145 

butter  milk,  146 

certified,  141 

composition  of,  140 

cow's,  141 

cream,  146 

culture  media,  140 

diseases  from,  142 

flash  method,  143 

holding  method,  143 

inspection  of,  165,  166 

pasteurization,  143 
Milk,  on  ship  board,  146 


INDEX 


493 


Milk,  skim  milk,  141,  146 

tsee  "Butter." 
see"Chee 
ilk-borne  di:-ea>es,  142 
cholera,  14:- 
diphtheria,  143,  390 
dysentery,  143 
milk  sickness,  142 
scarlet  fever,  142,  397 
Milk-borne  epidemics,  142 
Millepore  coral  polyps,  315 
Milner,  34 

Minnesota,  U.  S.  S.,  370 
Mittens,  188 
Mode  of  transmission 
ancylostomiasis,  413 
diphtheria,  385 
German  measles,  391 
malaria,  406 
measles,  394 
mumps,  400 
plague,  419 
pneumonia,  402 

.rlet  fever,  397 
tapeworms,  415,  416 
trench  fever,  421 
tuberculosis,  403 
typhoid  fever,  409 
typhus  fever,  422 
whooping  cough,  300 
yellow  fever.    . 
Mole-hott,  136 
Mollusks,  311 

terey,  U.  S.  S.,  316 
Moore,  322 

'»»  51 

Morphia,  -terile  solutions  of,  250 
Mortality  rate  in  I*.  S.  A.,  1914,  1915, 
Mortuary  room  on  hospital  ship,  332 
Mi.-' jiiit'T-.    \nophelime,  406 

breeding  places.  408 

in  camp. 

crude  oil,  408 

khaki  color,  i 

malaria,  405 

nets,  406,  408,  419 

screens,  406 


Mosquitoes,  smudges,  408 

Stegomyia  calopus,  418 

volatile  oils,  408 

yellow  fever,  418 
Mountain  sickness,  21 
Mouth,  the,  261,  453 
Moving  pictures,  349 
Muki-Muki,  309 
Mumps,  400 

period  of  incubation,  400 
Munday,  67 

Munson,  Col.  E.  L.,  U.  S.  Army,  395 
Muraena,  311 
Musca  domestica,  325 
Musicians,  apprentice,  enlistment  of,  456 
Mustard  gas,  357 
Mutton,  140 

Myalgia,  in  fire  room  force,  198 
Myoxocephalus  bubalis,  312 
Myoxocephalus  scorpius,  312 

Xankavill,  421 

Naphthalene,  426 

Naphthol,  426 

Naphthylamine  hydrochloride  solution, 

IOO 

Natural  ventilation,  see  "Ventilation." 
Naval  architecture,  13 
development  of,  4 

its  effect  on  naval  hygiene,  7 
Naval  auxiliary  crew,  329 

service,  458 

Naval  hospital  fund,  439 
Naval  militia,  458 

il    Medical    officers,  duties    of,  see 

"Medical  officers." 
Navy,  see  United  States  Navy. 
2       "N    C    I     '  322 

:or  americanus,  413 
Neck,  262,  454 

Neill  Robert-on  >tretcher,  255 
isser,  42 

•1,  29 

Nephritis,  344 

Nervous  strain  standing  watch,   192 
Nervous  system,  352,  362 
diving,  291 


494 


INDEX 


Nervous  system,  epilepsy,  362 

exhaustion  psychosis,  362 

prophylaxis,  364 

shell  shock,  363 

submarines,  281 

wounds,  363 
Nessler's  reagent,  98 
Neurasthenia,  360,  363 
Nicolle,  422 
Night  marching,  339 
Nitrates,  in  water,  92 
Nitrites,  in  water,  92 
Nitrochloroform,  322 
Nitrogen,  22,  23 

amount  required  in  body,  131 

in  food,  128,  130 

gases,  30,  32 

as  nitrate,  101 

as  nitrite,  100 
Nits,  323 
North  Dakota,  U.  S.  S.,  64,  204,  293, 

294,  324,  325,  326,  390 
Nose,  the,  261 
Notter,  71 

Nurse  Corps,  health  record,  460 
Nuts,  151 
Nutritional  diseases,  134,  365 

beri-beri,  365 

scurvy,  365 

Oatmeal,  ^149 
Oats,  149 
Obermeier,  422 

Odors  from,  fouled  scuppers,  40 
gasolene,  39 
paint,  40 
turpentine,  40 
water  closets,  40 
(Edema,  346 
Officers'  laundry,  210 

staterooms,  air  space  in,  49 
uniforms,  boat  cloak,  180 
cold  weather,  177 
dungarees,  180 
foot  gear,  184 
head  gear,  180 
overcoat,  180 


Officers'  uniforms,  rain  clothes,  184 
warm  weather  clothes,  174 

water  closets,  233 
Ohio,  U.  S.  S.,  248 
Oil  engines,  276 

Old,  Surgeon  E.  H.  H.,  U.  S.  Navy,  314 
Oleomargarine,  146 
Open  fires,  70,  71 
Operating  room,  hospital  ship,  330,  332 

on  ship  board,  246 
Opium,  355 
Opsanus  tau,  312 
Organic  matter,  in  air,  35 
Osborne,  133 
Osier,  364,  396,  397 
Oudard,  311 
Outline  figure  card,  460 
Overcoat,  180 

Owens,  Surgeon  W.  D.,  U.  S.  Navy,  355 
Oxalic  acid,  standard  solution  of,  104 
Oxygen,  22,  266,  271,  274 

consuming  power  of  water,  92,  104 

for  frost-bite  or  trench  foot,  344 

in  food,  128 

inhalations  at  high   altitudes,    16, 

267,  274 
for  the  apparently  drowned,  306 

on  submarines,  276 
Oysters,  155 

typhoid  fever,  155 
Ozone,  22,  29,  no,  116 

Paint,  odors  from,  40 

Palladium  salts,  44 

Paper  towels,  232 

Pappenheimer,  421 

Paralysis,  from  poisonous  fish,  309 

Paragonimus  westermanni,  376 

Parasitic  skin  diseases,  227 

Paregoric,  354 

Park,  389 

Paroxysms  of  malaria,  405 

Parsons,  122 

Parts  of  the  ship  and  health,  i< 

bakery,  202 

barber  shop,  204 

baths,  226 


INDEX 


495 


Parts  of  the  ship  (cont'd),  bedding,  222 

boating,  214 

brig,  207 

butcher  shop,  208 

coaling  ship,  213 

deck  watch,  192 

engine  room,  194 

engineer's  wash  room,  227 

fighting  tops,  194 

fire  room,  196 

galley,  200 

garbage  disposal,  237 

handling  room,  199 

heads,  229 

ladders,  199 

laundry,  210 

refrigeration,  227 

search  lights,  192 

sewage  disposal,  229 

small  boats,  214 

steering  engine  room,  212 

under  repair,  237 

water  closets,  229 
Pasteur,  in 

Pasteur-Chamberland  filter,  in 
Pasteurization,  143 

flash  method,  143 

holding  method,  143 
Pathological    laboratory,    on    hospital 

ship,  332 
Patterson,  421 
Pay  account  of  patient,  336 
Pea  coat,  180 
Peacock,  322 
iVurl  divers,  284 
150 

canned,  150 

dried,  150 

green,  150 
Pediculus,  321 

humanus,  or  capitis,  321,  3.24 
eradication  of,  324 

pubis,  321,  323 
eradication  of,  323 

vestimeni,  or  corporis,  321 

eradication  of,  322 
I  Yllagra,  134 


Pelor  filamentosum,  312 

Pennsylvania,   Health   Department  of, 

429 

Pennsylvania,  U.  S.  S.,  48,  49 
Pennyroyal,  408 

Per  capita  air  space  on  submarines,  277 
Percentage  of  sick,  439 
Perflation,  50,  51 
Perineum,  263 
Period  of  incubation,   see  Incubation, 

period  of. 
Perlzweig,  153 
Peroxide  of  hydrogen,  29 
Persons,  Medical  Director,  R.  C.,  U.  S. 

Navy,  419 

Personal  hygiene,  see  Hygiene,  personal. 
Personal  prophylaxis,  malaria,  408 

venereal  disease,  382 
Peruna  condemned,  354 
Pettenkofer,  28,  46 
Petty  officers  (chief),  head  gear,  180 

overcoat,  180 

uniform  of,  177 
Pflugge,  32,  33 
Phenol,  426 

disinfectants,  323 
Phenolsulphuric  acid,  101 
Philippine  government,  366 
Phosphorus,  320 

in  food,  128 

salts  of,  in  body,  132 
Phthirius  pubis  (pediculus  pubis),  321, 

323 

extermination  of,  323 
Physalia,  as  poison,  315 
Physalia  pelagica,  315 
Physical  examination,  of  air,  43 

of  recruits,  see  Recruits,  447 
Physical  properties,  of  water,  76 
Picket  lines,  343 
Pith  helmet,  183 
Pits,  kitchen,  338 

sullage,  338 
Plague,  325,  376,  419,  432 

bubonic,  419 

clothing  for  physician,  420 

Ileus,  419 


496 


INDEX 


Plague,  fumigation  of  ship,  421 

immunity,  420 

mode  of  transmission,  419 

period  of  detention  of  ships,  421 

prophylaxis,  420 

pneumonic,  419 

rats,  419 

septicaemia,  419 

vaccination,  420 
Plasmodium  falciparum,  405 

malarial,  405 

vivax,  405 
Pleadwell,  Medical  Director  F.  L.,  U.  S. 

Navy,  344 

Plenum,  and  exhaust,  60,  62 
Plenum  system  of  ventilation,  60,  62 
Plotosus  anguillaris,  312 
Plotz,  422 
Plumert,  48 
Pneumococcus,  42,  401 

mucosus,  401 
Pneumonia,  375,  376,  401 

bacteriology,  401 

carriers,  disinfection  of,  402 

immunity,  402 

mode  of  transmission,  402 

mortality  rates,  401 

prevalence,  402 

prophylaxis,  402 

types  of,  401,  402 

serum,  401 

Pneumonic  plague,  419 
Poison  gas,  357 
Poisoning,  arsenic,  35 

lead,  35 
Poisonous  fish,  bites  or  stings  of,  311 

flesh  of  fish,  309 
species  of,  310 
symptoms  of,  309 

glands  in  mouth  of  fish,  311 
in  fins,  313 
and  spines,  312 
in  tail,  313 

jelly  fish,  314 

Portuguese  man-of-war,  315 

sea  urchins,  313 

treatment  for,  313 


Poisonous  gr-   ^s  in  air,  30 
Poisonous  n      Is  in  water,  92 
Poliomyelitis   328 
Pollution  of  ^rater,  see  Water. 
Pollutions  ol  air,  29,  30,  37,  41 

see  Air. 
Polyneuritis,  365 

gallinor      /  134 
Potassium,  i       »od,  128 

salts  of,  ly,  132 

Potassium  CT         ate,  103 
Potassium    nitrate,    standard    solution, 

102 
Potassium  permanganate,  no,  115 

method,    29 

standarc  solution,  104 
Pork,  tapew  rm  from,  416 
Portuguese  i.r  a-of-war,  315 
Postmortem  stains,  435 
Powder,  foot,  341 
Prausnitz,  42 
Pressure,  air,  ^19,  20,  266 

water,  287 
Prevalence,  ancylostomiasis,  413,  414 

cerebro         .1  fever,  391 

dysentei    ,414 

pneumonia,  402 

small-pox,  398 

Prioleau,  Surgeon  P.  F.,  U.  S.  Navy,  316 
Proglottides,  415 
Prophylactic  measures,  2 

in  war,  3 
Prophylactic  treatments,  on  ship  board, 

248 
Prophylaxis,  ancylostomiasis,  414 

cerebrospinal  fever,  393 

chicken-pox,  399 

cholera,  417 

dengue,  419 

diphtheria,  385 

dysentery,  415 

Germa'       jasles,  391 

heat  cr       is,  372 

jaundice,  infectious,  422 

malaria,  406 

Malta  fever,  422 

measles,  394 


I 


INDEX 


497 


Prophylaxis,  mumps,  40 
nervous  system,  364*  3 
plague,  420 
pneumonia,  402 
jxuson  gas,  358 
relapsing  fever,  422 
scarlet  fever,  397 
seasickness,  359 
small-,**,  398 
tapeworm,  41 
trench  fever,  4 -M 
foot,  343 

kidney,  or  nephritis,  344 
tuberculosis,  404 
typhoid  fever,  2,  400 
typhus  fever,  422 
venereal  diseases,  38 jC 
war  strain,  364 
whooping  cough,  391 
yellow  fever,  418 
Prostitutes,  as  spies,  381 
Psychic  exhaustion,  362,  ,563 
Psychosis,  exhaustion,  362 

tein,  130,   134,   135.   M6,   J38,   141, 

148,  149,  150, 
inferior,  130,  131 
superior,  130,  131 

ychopathic  ward  on  hospital  ship,  333 
ychro  meter,  25 

sling  psychrometer,  27,  28 
wet  bulb  thermometer,  25 
Public  Health  Service,  435 
Pugh,  Medical  Inspector.  \\ 
Navy,  315 

Pulmonary  edema,  357 

tuberculosis,  403 
Pulmotor,  307 
Purification  of  water,  sec  Water. 


U.  S. 


Quan 
Quar 

I 


antico,  water  at,  109 
antine,  432 

scarlet  fever,  397    KTI  n 
Quartan  malaria,  405 
Quinine,  406 

Rabbits  for  diagnostic  work,  332 
Radiation,  70 

from  body,  171 

32 


Rain  clothes,  184 

arctic  overshoes,  187 

mackintosh,  coat,  184 
suit,  188,  191 

oil  skins,  184 

rubber  boots,  184 

south  westers,  184 

waders,  191 
Rain  water,  83,  83 
Rainfall,  84 

Rate  of  progress  for  troops,  339 
Rates  per  1000  of  admissions,  440 

deaths,  440 

invalidings,  440 
Ration,  U.  S.  Navy,  138 
Rats,  carriers  of  plague,  420 
Rays,  actinic,  122 

heat,  122 

infra-red,  121,  122 

ultra-violet,  121 
Rays,  the  (fish),  313 
Reaumur,  18 

Recompression,  in  diving,  291 
Recovery  room  in  hospital  ship,  332 
Recruiting,  257 

abdomen,  263,  454 

age  of  recruits,  448 

arms,  262 

aviation,  267 

causes  of  rejection,  264 

chest,  262,  454 

coal  passers,  450 

color  perception,  249,  452 

cursory,  general  view,  258 

descriptive  list,  264,  460 

disqualifications,  general,  453 
special,  453 
261,  453 

examination  of  joints,  263 

eyes,  258 

finger  prints,  4(10,  4^4 

firemen .  450 

irrm-ral  intelligence,  449 

hands,  262 

head,  258,  453 

health  records,  459 

hearing,  452 


498 


INDEX 


Recruiting,  heart,  262 

identification  records,  460 

intoxication,  450 

•lower  extremities,  263,  455 

lungs,  262 

measurements,  264 

mouth,  261,453 

naval  auxiliary  service,  458 
militia,  458 

neck,  262,  454 

nose,  261 

outline  figure  card,  460 

perineum,  263 

physical  proportions  for,  455 
Filipinos,  455 
midshipmen,  456 
minors,  456 
musicians  apprentice,  456 

recruiting  officer,  257 

re-enlistment,  448 

system  of  examination,  257 

teeth,  451 

term  of  enlistment,  448 

typhoid  prophylaxis,  458 

vaccination,  264,  458 

visual  acuteness,  260,  451 

weight,  264 
Reed,  328,  418 
Re-enlistment,  448 
Rees,  290 
Refrigeration,  227 

cooling  of  the  magazines,  229 
water,  229 

on  hospital  ship,  333 

preservation  of  food,  228 

production  of  ice,  229 
Rehabilitation,  364  , 
Relapsing  fever,  3,  422 

carried  by  lice,  321,  322 
bed  bugs,  325 

causes  of,  422 

prophylaxis,  422 
Relative  humidity,  denned,  24 

at  sea,  28 

tables,  26 

Resuscitation,  of  apparently  drowned, 
303 


Resuscitation,  artificial  devices,  307 

lungmotor,  308 

manual  methods,  303 

Schaefer  method,  303 

Sylvester,  306 
Retinal  hyperesthesia,  123 
Retinitis,  with  photophobia,  193 
Rettger,  45 
Rice,  149 
Rickets,  133,  134 
Ricketts,  422 
Riggs,  322 
Riggs,  Medical  Director,  C.  E.,  U.  S. 

Navy,  383 
Riley,  36 
Roaches,  319 
Roe,  fish,  147 
Rose  spray,  211 

Rosenau,  17,  36,  391,  406,  425,  430 
Ross,  405 
Rowland,  33 
Rubner,  135,  171 
Rum,  354 
Rye,  149 


Saccharine  preparations,  152 

alcohol,  153 

cane  sugar,  152 

confectionery,  152 

glucose,  152 

honey,  152 

maple  sugar,  152 

molasses,  152 
Sago,  151 
Sailor  hat,  183 
Salicylic  acid,  341 
Salmon,  363 
Salt  water,  79 
Salts,  in  the  body,  130,  132 
Sanitol,  426 

Santonin,  used  by  malingerers,  347 
Saturation,  deficit,  23 

definition,  23 
Scarlet  fever,  376,  396 

bacteriology,  396 

disinfection,  397,  398 


INDEX 


499 


Si -urlel  fever,  immunity,  396 

milk,  142 

mode  of  infection,  397 

quarantine,  397 

prophylaxis,  397 
Schaefer  method,  303,  ^o<S 
Schan/,  122 
Scheube,  309 
Schick  test,  388,  389 
Schmut/decke,  113 
Schotmiiller,  318 
Schroeder,  212 
Schiider,  142 
Schurmeier,  Captain  H.  L.,  U.  S. 

270 

Scolex,  415 
Scoops,  55,  56 
Scorpaena,  porcus,  312 

scrofa,  312 

Screens,  against  insects,  61,  62, 
327,406,  415 
t  ventilation,  56,  57 

weather,  192 
Scuppers,  odor  from,  40 
Scurvy,  128,  134,  365 

infantile,  142 

lime  juice,  365 
Sea  air,  constituents  of,  22 
Sea  anemones,  315 

protection  from,  316 
Sea  nettles,  314 
Sea  urchins,  313 

injury  by,  313 

Sra  water,  compoMtion  of,  82 
Search  lights,  192 

injury  to  eyes,  122 
Seasickness,  359 

diversion,  360 

etiology,  359 

prophylaxis,  359 

purgatives,  361 

will  jxnver,  361 
Sedgwick,  45 

Seilgwk'k-Tucker  aerobiosc«>p<  ,  . 
Sediment,  98,  108 
Seidlitz  powder 
Sellards,  415 


Septic  sore  throat,  142 

Septicaemic  plague,  419 

Septicemia,  312 

Sergent,  421 

Serological  work  on  hospital  ship,  332 

Serum  prophylaxis,  421 

Serum  therapy,  421 

infectious  jaundice,  422 

pneumonia,  401 
Service  record,  456 

of  patient,  336 
Sewage  disposal,  229 

canvas  chutes,  229 
Army,  dry  dock,  235 

heads,  229 

urinals,  231 

water  closets,  229 
Sewers,  422 
Shakespeare,  328 
64,  65,       Sharks,  309 

bite,  316,  317 

man-eating,  316 
Sheep  for  serological  work,  332 
Shell  rooms,  199 
Shell  shock,  363 
Shellac,  354 
Shiga-Kruse  type,  414 
Ship,  the,  bill  of  health,  432 

development  of,  4 
and  hygiene,  7 
of  submarine,  7,  n 

diseases  quarantinable  for,  432 

disinfection  of,  425 

division     into     compartments,     7, 
10 

electricity,  7,  9,  n 

formalin,  430 

fumigation  for  rats  in  plague,  421 

heating,  73 

intership  matches,  349 

parts  of,  13,  52 

from  plague  ports,  421 

preparation  for  disinfection,  427 
5  im,  7,  8 

substitution  of  steel  for  wood,  7,  8 

under  repair,  237 

varieties  of,  4,  12 


5oo 


INDEX 


Ship,  see  also  Air  aboard  ship. 

Parts  of  the  ship  and  health. 
Sick,  facilities  for  care  of,  on  ship 

board. 
Ventilation. 
Water. 

Shoes,  on  the  march,  341 
Shower  baths,  226 
Sick  bay,  242 

linen  from,  210 
Sick,  daily  average  of,  439 
Sick  day,  439 

Sick,  discharged  from  hospital  ship,  335 
facilities  for  care  of,  on  ship  board, 

242 

bath  room,  245 
battle  dressing  station,  249 
dentist's  office,  248 
dispensary,  242 
isolation  ward,  247 
operating  room,  246 
room  for  venereal  and  prophylac- 
tic treatments,  248 
sick  bay,  242 
store  room,  248 

transportation    of    sick   and    in- 
jured, 252 
the  ward,  242 
percentage  of,  439 
Side  cleaners,  220 
Silk,  168 

test  for,  170 

Silver  nitrate,  standard  solution,  103 
Sivel,  1 6 
Skim  milk,  146 
Skin,  453 

of  the  feet,  342 
Small,  19 

Small  boats  and  boating,  214 
awnings,  216 
burns  221, 

care  of  men,  215,  216 
danger,  218 

of  crushing,  219 
of  hooking  on,  220 
inspection  of,  216 
irregular  meal  hours  of  men,  216 


Small  boats,  Jacob's  ladder,  218 

overcrowding,  220 

sleeping  in,  215 

supplies  on,  219 
Small-pox,  398,  432 

etiology,  398 

immunity,  398 

period  of  incubation,  398 

prevalence,  398 

prophylaxis,  398 

U.  S.  S.  "Ohio,"  248 

vaccination,  398 
Smith,  Theobald,  405 
Smoke  pipes,  54 

Smoking  rooms  on  hospital  ship,  334 
Smudges,  408 
Snake  bite,  313 
Sneezing  gas,  358 
Soap,  227 

Soap  solution,  standard,  105 
Socks,  187 

of  marching  men,  341 
Sodium,  in  food,  128 

arsenite,  328 

bisulphate,  no,  115 

carbonate,  98 

fluoride,  320 

salts  of,  in  body,  132 
Sodium  nitrite,  standard  solution,  101 
Solanin,  152 

Soldiers,  minimum  space  in  barracks,  47 
Solveol,  426 
Soulima,  322 

Spanish- American  War,  328 
Spheroides  chrysops,  310 

hypselogencis,  310 

pardalis,  310 

rubripes,  310 

stictonotus,  310 

vermicularis,  310 
Spies,  381 
Spine,  453 
Spirillum  choleroe  asiaticae,  93,  41 

isolation,  from  water,  97 
Spirituous  liquors,  353 
in  cocoanuts,  354 
inspection  of  bottles  containing, 


INDIA 


501 


Spirituous  liquors  in  soft  drink  bottles, 

354 
Spirocha-te     icUTohcmorrhagira,      376, 

422 

Spit  kids,  376 
Splanchnic  system,  350 
Springs,  89 

Sputum-borne  diseases,  374 
classification  of,  376 
bacillary,  376 
cocci,  376 
flukes,  376 
spirochaete,  376 
unknown  causes,  376 
disinfection  of  sputum,  by,  374 
boiling,  374 
burial,  374 
burning,  374 
chemical  mean- 
(u-rman  cock  roach,  320 
paper  handkerchiefs,  375 
Squeeze,  21,  289,  290 
Staphylococcus  pyogenes,  42 
Starch,  131,  132 

corn  starch,  151 
Steam,  7 

benefits  of,  on  ships,  8 
as  disinfectant,  424 
introduction  of,  8 
Steam  heating,  71.  ;j 
Steam  hose  for  bed  bugs,  325 

for  flies,  327 
Steam  launches,  221 
Steel  -hips,  7,  8 
Steering  engine  room,  212 
Stegomyia,  419 

calopus.  418 
Steinfield,  402 

Stepp,  Surgeon  J..  I'    -    \  ,     ,  .  ^17 
terili/ation  of  water,  IOQ,  no 
boiling,  109,  1 10 
distillation,  IOQ,  1 10 
heat      exchange      i'pparat  u>,      109, 

•    ~> 

terili/ation  of  *\vimming  tanks  .^oo 
terilizing  room,  hospital  ship,  332 
Steyer,  16 


Stillson,  Chief  (iunner,  285 

Sting-ray,  313 

Stings  of  venomous  fish,  311 

Stitt,   Medical   Director   E.    R.,   U.    S. 

Navy,  45,  324,  401,  406 
Stockhausen,  122 
Stokes,  splint  stretcher,  253 
Stomach  bitters,  354 
Storage  batteries,  276 

gases  from,  40 
Store  rooms  on  hospital  ship,  334 

medical  supplies,  248 
Stoves,  71 
Street  dust,  41 
Streptococci,  93,  376 
mouth,  36 
sewage,  95 

Streptococcus  pyogenes,  42,  396 
Stretchers,  253 

canvas  litter,  254 
Lung  apron  stretcher,  256 
Neill  Robertson  stretcher,  255 
Stokes  splint  stretcher,  253 
Totsuka  stretcher,  256 
Stomoxys  calcitrans,  328 
Strychnine,  361 
Submarines,  7,  276 
accidents,  283 

U.  S.  S.  F-4,  283,  285,  289,  293 
air  pollution  on,  278 
artificial  ventilation,  280 
development  of,  n 
divers  dress  on,  290 
effect  on  health  of  men,  conjunctivi- 
tis, 282 

digestive  disturbances,  282 
effect  on  hearing,  281 
on  nervous  system,  281 
injuries  and  burns,  282 
lo>>  of  weight,  280 
heating  on,  74 
ventilation  on,  276,  277 
Sugar,  cane,  131 

for  heat  cramps,  371,  373 
milk,  131 
Suicidal  drowning,  303 

eating  poisonous  fish,  309 


5°2 


INDEX 


Sulphanilic  acid,  100 
Sulphur,  320 

dioxide,  426,  430 

in  food,  128 

salts  of,  in  body,  132 
Sulphuric  acid  fumes  on  submarines,  278 

dilute,  104 

Sunlight  as  disinfectant,  425 
Surface  water,  83,  84 

springs,  89 

Surgeon,  duties  of,  see  Medical  Officer. 
Surgeon  General's  Office,  379 
Surgeon  General,  U.  S.  N.,  Annual  re- 
port, 1917,  196,  303,  409 
Suring,  16 
Sutherland,  212 
Swedish  system,  351 
Swimming,  293 

compulsory  instruction,  293 

contests,  349 

drill,  294 

drowning,  293 

grab  line,  301 

high  dives,  300 

hours,  300 

a  psychosis,  294 

regulations,  301 

tanks,  297 

temperature,  300 
Sylvester  method,  306 
Symptoms,  ingestion  of  decomposed  fish, 

318 
of  ingestion  of  poisonous  fish,  309, 

311 

injuries  by  sea  urchins,  313 
poison  from  jelly  fish,  314,  315 
stings,  by  poisonous  fish,  312 

by  dorsal  fin  of  poisonous  fish, 

3T3 

by  tail  of  poisonous  fish,  313 
Synanceia  verrucosa,  312 
Syphilis,  261,  325,  374,  3?6,  380 
from  tattooing  needle,  356 
see  Venereal  Diseases. 

Tachycardia,    263 
Taenia  echinococcus,  417 


Taenia  saginata,  415 

solium,  416 
Tanks,  swimming,  297 

sterilization  of,  300 
Tapeworms,  415 

dibothriocephalus  latus,  416 

life  of,  415 

prophylaxis,  416,  417 

taenia  echinococcus,  417 
saginata,  415 
solium,  416 
Tapioca,  151 
Tattooing,  355 

syphilis  from,  356 
Taylor,  Alonzo,  132,  135 
Taylor,  J.  S.,  Medical  Inspector,  U.  S.  N., 

280 

Teeth,  261,  451 
Temperature,  16 

comfortable,  70 

critical,  19 

difference  in,  50 

in  engine  room,  194 

in  fire  room,  196 

human,  heat  cramps,  368 
malingerers,  346 
marching  men,  338 

man's  adaptability,  17 

in  Red  Sea,  59 

swimming,  300 

ventilation,  50 
Terminal  disinfection,  423 
Term  of  enlistment,  448 
Tertian  malaria,  405 
Testes,  undescended,  263 
Tetrachlorethane,  323 
Tetraodon,  309 

hispidus,  309 

lunaris,  310 
Thalassophryne  maculosa,  31 

reticulata,  312 
Theater  ship,  349 
Theatrical  performances,  349 
Thermometer,  17 

Centigrade,  18 

Fahrenheit,  17 

Reaumur,  18 


I 


INDEX 


503 


Thermometer,  wet  bulb,  25 
Thermo-ventilating  system,  73 
Thomas,  130 
Thompson  lamp,  259 
Tick,  cattle,  405 
Tiotin,  422 
Tissandier,  16 
Tobacco,  352 

cigarette,  352 

effect  upon  nervous  system,  352 

upon  heart,  352 
Tobacco  bag,  352 
Toe,  hammer,  263 
Toe  nails,  342 
Toilet  paper,  232 
Tonsillitis,  376 
Tooth  brush,  352 
Torpedo  drainage  tank,  39 
Totsuka  stretcher,  256 
Trachinus  araneus,  312 

draco,  312,  313 

radiatus,  312 
Trachymedusae,  314 
Trade  winds,  60 
Transmission  of  disease,  see     Mode  of 

Transmission." 
Transportation  of  sick  and  injured,  252 

of  troops  on  cars,  339 

on  truck,  339 

Traps,  for  cockroaches,  320 
Treatment  for,   ingestion  of  poisonous 
lish,  310 

post-mortem  decomposition  of  fish, 
3i8 

sting  «>r  biti-  of  poisonous  fish,  313 
Trench  fever,  421 

etiology,  421 

immunity,  421 

mode  of  transmission,  421 

period  of  incubation,  421 

prophylaxis,  421 
Trench  foot,  343 

prophyk 
Trench  kidney,  or  nephritis,  344 

prophylaxis,  344 
Trichlorethylene,  323 
Trigla  hirundo,  312 


Triple  vaccine,  410 
Tubercle  bacilli,  403 

in  butter,  146 
Tuberculosis,  42,  142,  258,  262,  374,  375, 

376,  403 

animals  dead  of,  as  food,  139 
bacteriology,  403 
contacts,  405 
early  diagnosis,  404 
immunity,  404 
from  measles,  394 
modes  of  infection,  403 

droplet,  403 

ingestion,  403 

inhalation,  403 
in  Navy,  293 

in  1916,  440 
predisposing  causes,  404 
prophylaxis,  404 
specific  cause  in  milk,  143 
Tubers  and  roots,  151 

inspection  of,  163,  164 

artichokes,  151 

beets,  152 

carrots,  152 

oyster  plant,  151 

parsnips,  152 

potatoes,  151 

sweet  potatoes,  151 

turnips,  152 
Tungsten  lamp,  125,  126 

life  of,  127 
Turpentine  kills  lice,  323 

odors  from  40 
Typhoid  fever,  2,  3,  142,  155,  352,  376, 

409,  432 

bacteriology,  409 
carriers,  233,  412 
disinfection,  412 
isolation,  412 
prophylactic,  2,  3,  409,  458 

inoculation,  411 

in  recruiting,  264 

on  ship  board,  242 

>ite  of  injections,  411 

statistics  in  U.  S.  Navy,  410 
specific  cause  of  in  butter,  146 


504 


INDEX 


Typhoid    fever,    specific    cause    of   in 

milk,  143 

spread  by  flies,  328 
in  U.  S.  Navy,  409 
Typhus  fever,  3,  422 
bacteriology,  422 
carried  by  bed  bugs,  325 

lice,  321,  322 
prophylaxis,  422 

Ultra-violet  rays,  121,  116 
Underclothing,  in  Navy,  173 

clean,  351 
Uniforms,  cold  weather,  177 

protective  color  of,  172 

warm  weather,  174 
Unlearnable  card,  260 
Uranoscopus  scaber,  3 1 2 
Urine,  in  heat  cramps,  368 

source  of  disease,  376 
Urinals,  231 

in  camp,  343 

self -flushing,  377 
Urticarial  symptoms,  315 
U.  S.  Army,  409 
U.  S.  S.  F-4,  283,  285,  289,  293 
U.  S.  Government  inspection  of  meat, 

139 

United  States  Navy,  air  space,  per  cap- 
ita, 48 

amusements,  349 

drowning  in,  293,  303 

morbidity  lists,  348 

mortality  lists,  348 

no  beri-beri,  366 

physical    examination    of    recruits, 

257,  447 
rations,  138 
regulations,  336,  447 

concerning  the  brig,  207 

"setting  up"  drill,  351 

tuberculosis  in,  293,  403,  440 

typhoid  fever,  2,  3,  409 
prophylactic,  2,  3,  409 

vaccination,  398,  458 
vital  statistics,  how  computed,  438 

admission  rate,  440 


United  States  Navy,  average  strength, 

438 

daily  average  of  sick,  439 
percentage  of  sick,  439 
sick  day,  439 

Vaccination,  242,  264,  458 

for  dysentery,  414 

for  plague,  420 

of  recruits,  264,  458 
Varicocele,  263 
Variot,  142 
Vaughn,  328 
Veal,  140 
Vegetable  foods,  148 

canned,  153 

edible  fungi,  152 

farinaceous,  148 
preparations,  151 

fatty  seeds,  151 

fruits,  152 

herbaceous,  152 

legumes,  150 

rotting,  326 

saccharine  preparations,  152 

tubers  and  roots,  151 

vegetable  fats,  151 
Vegetable  lockers,  breeding  places  for 

flies,  325 

Vegetable  proteins,  130 
Venereal  diseases,  263,  379 

admission  rate,  U.  S.  Navy,  380 

alcoholic  drink,  382 

in  the  barber  shop,  205 

diversion,  382 

education  concerning,  381 

in  the  galley  force,  202 

gonorrhoea,  263,  352,  380 

on  the  march,  338 

occupation,  382 

prevalence  of,  379 

prevention  of,  381 
personal,  382 

prophylactic  treatment,  383 
results  of,  383 
room  for,  248 

prophylaxis,  general,  382 


INDEX 


505 


Venereal  diseases,  quarantine,  381,  382 
on  submarines,  282 
syphili>.  l6l,  325,  374,  376,  380 
ward  on  hospital  ship,  333 
\Vnom  apparatus  in  fish,  311 
bites,  311 
jelly  ti>h.  31 4,  315 
poison  gland  above  palate,  311 

connected  with  spines,  312 
Portuguese  man-of-war,  315 
sea  urchins,  313 
Ventilation,  46 

artificial  ventilation,  60 
on  ship  board,  63 
dangers  of,  66 
electric  blowers,  69 
electricity,  9 
engine  room,  194 
fireroom,  196 
hospital  ship,  334 
insects,  61,  64 
screens,  61 

on  submarines,  277,  280 
thermo-ventilation,  73 
U.  S.  S.  "Pennsylvania,"  48 
on  shore,  60 

combination  of  plenum  and  ex 

haust,  62 

exhaust  system,  62 
plenum  or  supply  >y>tem,  60 
terminals  of,  <n .  <>- 
terminals,  location  of.  oj 
natural,  50 

aspiration,  50,  51 
Black  Hole  of  Calcutta,  48 
diffusion,  50,  51 
humidity.  50,  51 

The  Londonderry!  48 

motion,  50,  51 
per tla lion,  50,  51 
temperature.  50 
on  ship  IxKird.  q  i 

air  ports.  53,  54 

ammunition  h«»i>t-. 

rargo  p«.:- 

chutes,  53,  55 

coaling  ship,  213 


Ventilation,  natural,  on  course  of  ship, 

58,  59 

cowls,  52,  53 
direction  of  wind,  58,  59 
elevator  shafts,  53,  55 
gun  ports,  53,  55 
hatches,  52,  53 
peculiarities   of    locality,    58, 

5Q 

scoops,  55,  56 
screens,  56,  57 
smoke  pipes,  53,  54 
speed  of  ship,  58,  59 
velocity  of  wind,  58 
voice  tubes,  53,  55 
wind  sails,  56,  57 
see  Heating. 
Ventilation  officer,  64 
Vera  Cruz,  177 
Vermijelli,  322 
Vermin,  223 

in  bedding,  224 
cholera,  417 
in  laundry,  211 
plague,  420 
small-pox,  399 
sulphur  dioxide,  430,  431 
in  toilets,  231 
Vibrio  cholerae,  42 
Vincent's  angina,  376,  390 

in  galleys,  202 
Vi>i»>n,  in  aviation,  267 
\  i>ual  acuteness,  451 
Vital  statistics,  how  computed,  438 
average  strength,  438 
daily  average  of  sick,  439 
percentage  of  sick,  439 
rati-s  of  admission,  440 
deaths,  440 
invaliding?,  440 
>ick  day,  439 
Vitamiru-s,  130. 

and  heri  heri,  365 
Voice  tubes,  55 
\'<>it,  28,  136,  137,  150 
Volhynian  fever,  421 
Vomiting,  feigned,  345 


INDEX 


Von  Pirquet,  404 
Von  Schroetter,  270 

Walker,  33,  415,  429 
Ward,  121 

Ward,  the  berthing  capacity,  242 
carriage,  332 
deck  covering,  243 
lighting,  243,  244 
medical,  331 
steel  lockers,  244 
surgical,  331,  33  2 
ventilation,  243 
Wash  basin,  351 
Washington  milk,  144 
Watch  cap,  183 
Water,  76 
algae,  86 
analysis,  92 

bacteriological,  93 
chemical,  92 

qualitative  bacteriological,  95 
quantitative  bacteriological,  94 
animal  parasites,  108 

matter,  decomposing,  92 
artesian,  83,  85 

well,  91 

Bacillus  tuberculosis,  405 
characteristics  of,  85 
chemical  examination  of,  97 
alkalinity,  107 
ammonia,  albuminoid,  100 
free,  98 
standard,  99 
color,  98 

incrustants  in,  107 
nitrogen  as  nitrate,  101 

nitrite,  106 
odor,  98 

oxygen  consuming  power  of,  104 
poisonous  metals  in,  108 
sediment,  98 
total  solids,  98 
turbidity,  98 
deep  well,  83,  85 
definition  of,  76 
food,  as,  130,  134 


Water,  foul,  cause  of  infectious  jaundice 

in,  422 

fresh,  in  camp,  342,  343 
ground,  83,  84 
hard,  82,  85,  106 
of  hygroscopicity,  171 
of  interposition,  171 
man's  needs,  76 
meteoric,  83,  88 
minimum,  per  capita,  77 

on  hospital  ship,  331 
permissible  limit  of  pollution,  108 
physical  properties,  76 
pollution  of,  86 
chemical,  86 
mechanical,  86 
permissible  limits,  108 
vegetable  contamination,  86 
potable,  87 

analysis  of,  107 
appearance  of,  87 
odor,  87 
pressure,  287 
purification  of,  77,  109 
chemical,  109,  113 
alum,  109,  114,  118 
bromine,  109,  114 
calcium      hypochlorite,      109, 

114 

chloramine  -T,  no,  116 
chlorine,  77,  103,  109,  114 
Darnall  Siphon  Filter,  118 
halogen  group,  109,  114 
halozone,  118 
hydrate  of  iron,  no,  115 
iodine,  109,  114 
Lyster  bag,  117,  119 
ozone,  no,  116 
potassium  permanganate,  no, 

sodium  bisulphate,  110,  1:5 
ultra-violet  rays,  no,  116 
filtration,  109,  in 
domestic,  109,  in 
Berkefeld,  109,  in 
Pasteur-Chamberland,     109, 


INDEX 


507 


ater,purification  of,  municipal,  109, 112 
mechanical,  109,  113 
slow  sand,  109,  112 
sterilization  with  heat,  109,  no 
boiling,  109,  no 
distillation,  77,  109,  no 
heat  exchange,  109,  no 
nuantiro,  at,  109 
rain,  83,  88 
reaction,  87 

salt  water,  dangers  of,  79 
sea  water,  composition  of,  82 
sediment,  98,  108 
soft,  85 
sources  of,  88 
rain,  88 
surface,  89 
well,  90 

storage  on  ships,  81 
on  ship  board,  77 
on  shore,  83 
surface,  83,  84,  89 
ta>te,  87 
well,  90 
artesian,  91 
dug,  90 

filtration  into,  91 
tubular  or  driven,  90 
Water  home  disease  on  ship  board,  8 
Water  closets,  229,  351 

»        hospital  ships,  334 
number  required.  231 
odor  from,  40 
submarines.  281 
Water  rl«i>et 
trew,  231 
lire  on,  324 
for  officers,  233 
ater  tanks,  cleansing  of,  81 

cisterns,  88 
eichselbaum,  391 
Weight,  264 

loss  of,  on  submarines,  280 
midshipmen,  456 
minors,  456 

musicians  (apprentice),  456 
recruits,  455    ' 


Weil's  disease,  422 
Wells,  artesian,  85,  91 

driven,  90 

dug,  90 

tubular,  90 

Wet  bulb  thermometer,  25 
Wheat,  148 
Whooping  cough,  376,  390 

immunity,  391 

incubation,  390 

mode  of  transmision,  390 

prophylaxis,  391 
Widal  reaction,  412 
Wild  heat,  194,  195 
Wiley,  149 
Wilshire,  363 
Wind,  definition,  19 

causes  of  wind,  20 
Window  space,  for  air,  51 

for  light,  122 
Windsails,  56,  57 
Wolpert,  43 
Wood,  135 
Wood  alcohol,  354 

cause  of  blindness,  354 
Wool,  1 68,  171 

test  for,  170 

advantages  of,  172 
Wounds,  363 

paralyses  from,  364 

rehabilitation,  364 
Wrestling  matches,  349 

Xenon,  29 

X-ray  room  on  hospital  ship,  333 

Xylyl  bromide,  357 

Yellow  fever,  3,  376,  418,  432 

immunity,  418 

period  of  incubation,  418 

prevention,  41* 

Stegomyia  calopus,  418 
Yellow  jacket,  3 1 1 

Zinc,  in  water,  108 
Zingher,  389 
Zoantharia,  315 


YC  03053 


OF  CALIFORNIA  LIBRARY 


